-Caveat Lector-

Government Urged To Warn on Radium

By MELISSA B. ROBINSON
.c The Associated Press

WASHINGTON (AP) -- Steve Culpepper had endured blinding headaches, double
vision, brain surgery and the violent nausea of chemotherapy. Then a doctor
connected his cancer to nasal radium treatments he received as a boy.

Culpepper remembered that small amounts had been inserted through his nose to
treat chronic ear infections, but he never worried about it as he grew older.

Culpepper, who rarely got so much as a cold, had not had a physical in years,
much less a consultation about an obscure Cold War-era medical procedure no
longer used.

``If someone had said anyone having these treatments in the '50s or '60s
ought to immediately go see an ENT (ear, nose and throat) doctor, he would
have gone,'' said Culpepper's widow, Patti, of Newport Beach, Calif. ``I know
he would have gone.''

Culpepper, 55, died in January after 16 months of treatment for
nasopharyngeal cancer, which affects the nose and upper throat area.

The government sees no need to warn former radium patients, a stand that
enrages public health advocates.

``They're doing a great disservice to the population at risk and not meeting
any of their responsibilities,'' says Stewart Farber, a Rhode Island public
health scientist who has spent years researching the medical use of radium.

>From the 1940s to the mid-1960s, it was common practice in civilian and
military medicine to use nasal applicators containing 50 milligrams of radium
to shrink tissues at the entrance of the eustachian tubes. Those tubes help
drain and balance pressure on the inner and outer ear.

A typical regimen involved three to four treatments, of six to 12 minutes
each, a few weeks apart. Over that course, the tissues closest to the radium
capsules would have received a radiation dose about 100 times greater than
that received by survivors of the atomic bombings of Hiroshima and Nagasaki.

Nasal radium was given mostly to military pilots and submariners troubled by
drastic changes in atmospheric pressure and to children who suffered from
colds, tonsillitis, ear infections and sinus or adenoid problems.

The practice gradually was abandoned when the military started using
pressurized aircraft cabins, effective new treatments such as antibiotics
were developed, and questions were raised about radiation's health effects.

Years later, radium patients are complaining of tumors, thyroid and immune
disorders, brittle teeth and reproductive problems.

Public health advocates say the government should warn former radium patients
that they could be at risk of contracting cancer or other diseases. They say
notification could save lives by prompting people to get checkups or at least
to discuss the matter with doctors.

But the Centers for Disease Control and Prevention said diagnostic tests are
unnecessary for anyone who does not show symptoms of a problem.

``Current studies do not indicate substantial increases in risks for ...
disease among those who received NP (nasopharyngeal) radium treatments,'' the
agency said in the March 29, 1996, edition of its weekly morbidity and
mortality report.

Farber contends CDC specialists are ignoring important evidence of radium's
health risks.

``It's severely impeachable science,'' he said.

By the CDC's own estimate, as many as 2 million people were treated with
nasal radium.

The government has taken some steps to help.

Last year, Congress required the Department of Veterans Affairs to provide
health care to veterans who had radium treatments and were suffering head or
neck cancer. But little has been done for civilians.

The CDC has cited various studies, two of which dealt specifically with nasal
radium.

One 1982 study in Maryland of hundreds of people who had nasal radium from
1943-60 found four cancer deaths -- three of the brain and one of the soft
palate -- in the treated group, compared with none in people who were
untreated as children. A follow-up study is awaiting agency review.

Dr. Anne Mellinger-Birdsong of CDC's National Center for Environmental Health
said the findings were too small to draw broad conclusions.

Nevertheless, she said, ``If necessary, we're going to revise our
recommendations.''

CDC's approach has not been completely hands-off. The CDC once urged patients
who had nasal radium to tell their doctors and posted information about the
treatment on the Internet.

But what about those who do not remember?

Mellinger-Birdsong said most people probably will recall such an
uncomfortable treatment and can get a physical if they are worried.

If they do not remember, ``we don't feel it would be that harmful,'' she
said.

The Culpeppers would disagree.

Before Steve Culpepper died in January, he told his family he was glad his
mother was not around to see him suffer.

``He said, `Thank God my mother died,' so she wouldn't have felt the guilt
for taking him for those radium treatments,'' Mrs. Culpepper said.

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