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RADIOISOTOPES; THE NUCLEAR CONNECTION

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

From the early 1930s, the development of artificial radioisotopes first took place with the construction of a range of particle accelerators including cyclotrons. The use of radioisotopes in medicine expanded. H o w e v e r radioisotopes were still hard to get through the 1930s. Particle accelerator technology w a s in its infancy. S o m e accelerators in the U S were used for uranium enrichment for weapons production during World W a r II, and the three that existed in Japan were destroyed by the invading U S a r m y in late 1945. F r o m the late 1920s until World W a r II, a nexus had formed between particle accelerators and nuclear medicine, then during the war accelerators were linked to nuclear militarism. These links were remoulded during and after the war. S o m e ongoing effort w a s expended on the development of particle accelerators, but they were developed primarily for physics research including military research. Far m o r e effort and funding w a s expended on the development of fission technology using nuclear reactors. (Brodsky et al., 1995;

Stelson et al., 1995; Boyd and Lane, 1973; Sasaki, 1995; Freeman, 1981, ch.4;

Cockburn and Ellyard, 1981, ch.9.)

The production of medical radioisotopes became a subsidiary function of nuclear research reactors. Inevitably, the U S w a s at the forefront of reactor radioisotope

production. Of the 65 research reactors in operation in 1957, only 10 were outside the U S (Coleby, 1987). The U K also produced reactor radioisotopes from the mid 1940s. Not long after, research reactors were being used in the Soviet Union for radioisotope production. Other countries with plans to develop nuclear power and/or weapons also had a need for research reactors. A s research reactors become more widespread, so too did reactor radioisotope production.

With perhaps just one exception - a small reactor built in the US for cancer treatment and limited radioisotope production - research reactors were not built specifically for medical purposes (Anon., 1959). Although medical radioisotope production w a s a secondary concern, artificially-produced radioisotopes were more widely available after World W a r II. There w a s a deluge of papers, speakers and publicity; over 3000 articles were published relating to medical uses of

radioisotopes from 1945-50 around the world. (Croll, 1994; Bindon, 1988; Brodsky et al, 1995; Coleby, 1987.)

Without the development of nuclear weapons and power programs, nuclear medicine would not have become integrated into medicine so rapidly, and m a y not have become a widespread medical application at all. Medical radioisotope production w a s a secondary function and sometimes marginalised because of the priority accorded to nuclear power and weapons research. Yet nuclear agencies were keen to support the development of nuclear medicine, which served an

important ideological, legitimating function. T h e production of medical

radioisotopes w a s accompanied b y m u c h publicity focused o n finding a cure for cancer and spiced with swords-to-ploughshares rhetoric. (Kotz, 1995.)

Financial incentives had little to do with the early development of nuclear medicine: there w a s little or n o profit to be m a d e in such an immature market.

Radioisotopes were typically supplied at little or n o cost - this occurred not just in the capitalist countries pursuing major nuclear p o w e r and/or w e a p o n s programs, but also in countries with modest nuclear research programs such as Australia and a n u m b e r of Latin American countries (Touya, 1987). Even before the end of the 1940s, s o m e private companies had carved out a niche as intermediaries between bulk radioisotope producers (i.e. nuclear agencies) and users (hospitals), but these companies did not play a significant role for s o m e decades.

The radioisotope industry can usefully be considered as a product of the symbiotic interests of nuclear agencies and medical professionals. M o r e broadly, class

interests were also at work, even if the profit motive w a s not an important driving force. A s well as serving as an ideological prop for the nuclear industry, radioisotope production and nuclear medicine fitted neatly with the ideologies of technological and medical progress that were so prominent in the post-war

decades. These various ideologies were evident in the rhetoric surrounding radioisotope production and nuclear medicine, such as the boastings of a former director of the O a k Ridge National Laboratory about the Laboratory's role in

"saving lives and m o n e y with isotopes" (Weinberg, quoted in O R N L , 1996):

// at some time a heavenly angel should ask what the laboratory in the hills of East Tennessee did to enlarge man's life and make it better, I dare say the production of radioisotopes for scientific research and medical treatment will surely rate as a candidate for very first place.

Much was made of the potential for radioisotopes to be used to cure cancer, but nuclear agencies, governments, and the capitalist media were far slower to

acknowledge the dangerous and iatrogenic effects of radiation - whether from weapons tests, reactor emissions, uranium mining or medical radioisotopes - and nuclear critics were routinely accused of being communists (Wasserman et al., 1982, ch.7).

For hospital managers/boards and doctors, the main motivations for

involvement in nuclear medicine were profit and prestige. Several specialties within medicine began experimenting with radioisotopes: "The added prestige,

training opportunities and facilities for clinical research which isotopes bring to these special units is considerable." (McRae, 1963.) M u c h could be said about the turf battles between different medical specialties and different occupations for control over nuclear medicine, but that would serve little purpose in this thesis.

The symbiosis between nuclear agencies and medical institutions works both ways. There is a long history of medical practitioners and researchers giving verbal support to the development of nuclear power, w e a p o n s and so on. Thus W a g n e r and Ketchum (1989), nuclear medicine specialists, blow the trumpet not only for medical uses of radiation but also for nuclear power. Brodsky et al. (1995, p.813) claim that the b o m b i n g of Nagasaki and Hiroshima "seems to have saved

millions of lives", talk about "environmentally clean and safe nuclear p o w e r and radioactive waste disposal", and are hostile to nuclear critics. Medical personnel and institutions sometimes strayed from the topic of radioisotope supply in submissions to the Research Reactor Review - for example the Flinders Medical Centre (1993) argued that H I F A R is an "important and prestigious" national facility, and failure to build a n e w reactor would result in a loss of international status which could be seen as an indicator of Australia's continued slide towards

"banana republicanism" and third-world status.

In other cases the support of medical personnel and institutions is more tangible, such as through their involvement in radiation dosimetry research and

regulation; this encompasses medical radiation along with m a n y other radiation sources such as reactor emissions and uranium mining. (Stelson et al., 1995;

Gofman, 1990).

The most sinister aspect of the symbiosis between medicine and nuclear programs was a series of radiation experiments carried out in the U S from 1944-1974. The

experiments were funded by a range of institutions including the Defence Department and the U S Atomic Energy Commission. A t least 31 contentious radiation experiments have c o m e to light, affecting u p to 800 people. Dozens of people, including prisoners, mental patients, children, and pregnant w o m e n , were injected with small quantities of plutonium. S o m e cancer patients were injected with uranium - to test the effects of uranium on tumours and/or to determine safe levels of exposure a m o n g uranium miners. Between 1961 and 1972 the

military sponsored w o r k in which at least 87 cancer patients were irradiated to test the effects of radiation o n cognitive and emotional processes. Justifications given for s o m e of the experiments referred to Cold W a r paranoia and overlapping notions of subjecting a few individuals to risks for the good of society as a whole.

In addition to tests performed directly o n individuals, a n u m b e r of tests were

conducted involving the deliberate release of radiation into the atmosphere.

(Roberts, 1994; Rhein, 1994; Advisory Committee o n H u m a n Radiation

Experiments, 1996.) Predictably, the nuclear medicine community has tried to distance itself from these experiments despite the involvement of the medical profession - thus an article o n the topic in The Journal of Nuclear Medicine w a s titled "Not Nuclear Medicine" (Miller, 1994B).

Far more widespread than military-medical experiments was the misuse of radiation (radioisotopes and x-rays) as a result of corporate and medical

profiteering, tied in with ignorance about the iatrogenic effects of radiation and a willingness to use medical patients as guinea pigs for experimental procedures without informed consent. Questionable experiments carried out in Australia in the 1940s and 1950s, which have received s o m e publicity recently, belong to this category of misuse (Bonnyman, 1994).

While nuclear medicine personnel and institutions have generally been staunch allies of all things nuclear, there has been the occasional dissent. For example in 1978, 74 doctors and scientists involved in nuclear medicine in Australia sent a petition to the federal government expressing their concern, and urging a cautious approach, to nuclear p o w e r on the grounds of waste disposal, radiation, pollution, and genetic risks. The petition w a s a response to attempts by the Citizens for

Uranium Export to lobby doctors to support uranium mining and export.

(Williams, 1978.) In 1993 the International Physicians for the Prevention of

Nuclear W a r called for a boycott on Siemens medical equipment (which includes nuclear medicine equipment) because of aspects of the company's involvement in the nuclear p o w e r industry. Siemens denies the boycott is having an impact but

"industry sources" say it is, particularly in Europe, according to a reporter in the M o v e m e n t Against U r a n i u m Mining's magazine The Third Opinion. (Anon., 19961.) Another falling out followed from the attempt of the Canadian Control Board to raise permissible radiation levels for workers and the public in 1983-84.

All the major unions representing Canada's 200 000 radiation workers, including medical radiation workers, banded together to oppose the changes which were subsequently dropped. (Babin, 1985, p.17.) O n e further example is the w o r k of a number of dissident doctors and scientists working in the field of radiation

research and regulation (see chapter 8.3). Little is to be m a d e of these examples;

they are rare exceptions and there is no sign that the bonds between nuclear medicine and nuclear agencies are becoming m o r e troubled with time.

Despite the support of nuclear agencies in the development of nuclear medicine, and the m u c h greater availability of radioisotopes from research reactors after the

war, nuclear medicine w a s still a small and weakly-established branch of medicine through the 1950s and early 1960s. Radiation detection equipment w a s

rudimentary and only a handful of applications for radioisotopes had been developed such as the use of iodine-131 for thyroid disorders, chromium for labelling red blood cells, potassium-32 treatment for leukaemia, and cobalt treatment for megaloblastic anaemia. (Kotz, 1995.)