SILENT DEATH

...In 1977, the Bureau of Radiation Health found that about 35 per cent of the mammograms being taken had technical problems affecting their usability...

...But Stewart's study, and a host of others, had indicated that even a single X ray could have disastrous effects on an infant in utero and other susceptible members of the community...

...The X-ray pioneers of the late Nineteenth Century had little understanding of the potential dangers of radiation...

...Alice Stewart of Oxford's Department of Preventative Medicine to search for a reason...

...They rarely bothered to protect their patients or themselves from overexposure...

...Most of the licensing pertains only to full-time X-ray equipment operators and does not cover people who operate the machines part-time...

...The size, type, and location of the cancer dictates the precise form of therapy used...

...An X ray of the breast can reveal tumors in their early stages, and thus can have beneficial results...

...They must then pass a national examination before practicing...

...Proponents of nuclear power and weaponry have tried to block public awareness of low-level radiation risks Stewart soon found herself under a barrage of criticism...

...epidemic of cancer in medical history...

...By 1976, about 1,800 cases of breast cancer had been detected...

...There is no question that X rays can perEleanor Walters and Harvey Wasserman are co-authors, with Norman Solomon and Robert Alvarez, of "Killing Our Own: The Disaster of America's Experience with Atomic Radiation," from which this article is adapted...

...Today, the use of radioactive substances to treat a wide range of diseases—and particularly cancer—is becoming increasingly sophisticated...

...The practice may well have damaged countless people's feet, and scatter radiation from the relatively cheap machines may have done other damage as well...

...The idea of using X rays to detect breast cancer gained credence in the 1930s...

...The radiation doses are not inconsiderable, ranging as high as 45,000 millirems for some scans...

...In 1974, after Betty Ford and Happy Rockefeller underwent mastectomies, the interest in methods of preventing breast cancer soared...

...There are those— particularly pregnant women and their unborn children—who have already suffered from the misuse of this medical miracle...

...Though he was severely burned in 1896, Dally continued X-ray work for two more years...

...In August 1981, under intense pressure from the radiation health community, Congress passed a law requiring the states to establish Federally approved programs for the training and licensing of radiological technicians...

...The programs are to be in place by 1985...

...Doctors who invest thousands of dollars in X-ray machines may well be inclined to use them more than absolutely necessary in an attempt to recoup their investment...

...The radiation burned away his buttocks and destroyed his right hip, leaving him, in the words of his lawyer, "hopelessly and totally disabled...

...If doctors are largely ignorant of the potential health effects of the X-ray machines in their offices, the roughly 150,000 people who actually operate them often understand the dangers even less...

...According to radiological health specialist James L. Walker, many dentists "feel that the dental X ray is a tiny, tiny exposure and it's not really a hazard...

...Despite Kline's case and a growing controversy over the uses and abuses of radiation, portions of the medical profession remain enthusiastic...

...Apparently, X rays have contributed to the problem instead of helping to solve it...

...One of the world's first and biggest radiation surveys was conducted in the mid-1950s on the effects of X rays on unborn children, and it has had an important effect on all debate over safe radiation exposure levels since...

...She was having trouble breathing...

...The doctor said it would be good to have as a base against which to compare future X rays in case pneumonia developed...

...The American Cancer Society has suggested that women under thirty-five be given mammographies only if there is clear evidence of a need for them...

...There continues to be widespread debate over the advisability of such therapy, and the possibilities of natural, alternative cures...

...John C. Bailar III, writing in the Annals of Internal Medicine, warned that the Health Insurance Plan study, which had prompted so much faith in mammography, had not, in fact, demonstrated any increase in survival rates among the women under fifty who had been given the X rays...

...Hewitt's and Stewart's findings jeopardized those practices and threw into doubt the entire foundation of the safety standards for radiation...

...Those with a history of asthma, hives, eczema, allergies, pneumonia, dysentery, and rheumatic fever showed a higher risk of contracting leukemia after being X-rayed than healthy children...

...Such radiation treatments were common from the 1920s through the 1950s, and were also deemed acceptable for treating enlarged thymus and thyroid glands, enlargement and inflammation of tonsils and adenoids, deafness due to hypertrophy of lymphoid tissues around eustachian tubes, ringworm of the scalp, cervical and other types of inflammation, tuberculosis of cervical nodes, asthma, whooping cough, and even breast problems after birth...

...In fact, even as late as 1979, during the accident at Three Mile Island, nuclear proponents were arguing that exposure levels from the plant were comparable to a single X ray, and thus safe...

...Ironically, because the breast tissue of younger women is denser than that of older women, detection of cancer in younger women through mammography is often more difficult...

...The study began when David Hewitt, a statistician at Oxford University, noticed that in the preceding few years there had been an increase of more than 50 per cent in the number of British children dying of leukemia...

...Dally died that October, prompting Edison to abandon radiation research in his laboratory...

...Helmuth Ulrich found the leukemia rate among radiologists to be eight times that of other doctors...

...Though infants in utero and women have proved extremely sensitive to X rays, the problem is not restricted to them...

...A one-year fellowship in a specialty may also be taken...

...Every indicator suggests that caution is advised...

...radiation can also be used to destroy cancerous cells in the body, and to arrest the spread of the disease...

...MacMahon compared the children of 70,000 mothers who had received X rays during pregnancy with the children of mothers who had not been X-rayed...

...D. W. Gage of McCook, Nebraska, writing in New York's Medical Record, noticed cases of hair loss, reddened skin, skin sloughing off, and lesions...

...In 1970, the last year in which the Federal Government analyzed X-ray records on a national scale, it found that 23 per cent of the 3.5 million pregnant women in the United States were exposed to medical X rays—some 80,000 women...

...location of various cancers, internal diseases, and malformations^—all have become possible with the use of X rays, and all have resulted in the alleviation of pain and the saving of lives on a mass scale...

...This device, introduced in 1973, can perform precise examinations of the brain and, more recently, the whole body...

...Dally frequently tested the output of radiation tubes by placing his hands directly in the beam...

...treatment of bone fractures...

...Twenty-seven programs were set up with the goal of examining a quarter of a million women...

...Only California, of all the fifty states, requires that all X-ray machine operators be specially trained...

...Some changes were made, she said, but had the program continued as originally planned, it might have caused up to twelve breast cancers for every one it picked up...

...But the question remains whether this early enthusiasm for yet another use of radiation may someday result in a long list of studies on unexpected side effects, as has the use of medical X rays...

...The average skin dose per dental X-ray film is about 910 millirems, almost triple the' whole body dose from background radiation...

...two years later his left arm was amputated for the same rea--son...

...X-ray equipment is costly, and as the state of the art quickly changes, older but still usable models become obsolete...

...Many of the technicians administering dental X rays are no better trained than those working in doctors' offices...

...As a result, X-ray diagnosis has rightfully taken its place as a vital and necessary part of medical therapy throughout the world...

...Bedridden since May 1978, Kline recently won a $2 million malpractice settlement...

...Radiology grew from a specialty of only a few hundred practitioners in 1913 to a burgeoning profession with more than fifteen thousand people in 1981—roughly 6 per cent of the nation's physicians...

...In the early years of radioactive science it was widely believed that radium had immense curative properties, in large part because its rays affected tissue growth...

...The new findings indicated that a single rad of X-ray dosage to an infant in utero could lead to a higher chance of childhood leukemia...

...form important medical services, and that their use has made an inestimable contribution to human health...

...Women carry their eggs from birth, and Stewart found X rays would be particularly harmful if they affected the mothers' ovaries...

...Proponents of atomic power and weaponry have long been concerned that indications that small doses of X rays may be harmful would reflect badly on the viability of atomic reactors and the safety of bomb testing...

...If one million women each receive 1,000 millirem of X rays, between 50 and 200 can be expected to develop breast cancer as a result," he said...

...With fluctuating power ratios and errant beams, doctors, patients, machine operators, and bystanders were exposed...

...Stewart's initial study, for example, was the first major epidemiological indication that low-level fallout could be far more dangerous than the currently accepted limits...

...Though the X-ray industry and its medical proponents emphasize that the doses from diagnostic radiation are small, considerable evidence has surfaced indicating that the health effects can be devastating, particularly to the unborn fetus...

...In 1902 his right arm was amputated at the shoulder to arrest the spread of skin cancer...

...While rotating, the scanner can take thousands of radiographs in a few minutes and create a computer-processed cross-section view of the patient's body on a video screen...

...A lot of this I blame on the nuclear establishment," she said, "which has gone out of its way to convince everybody that low-level radiation is no hazard...

...By 1972, results indicated that children with chronic diseases were also at special risk from low levels of X ray...

...Stewart also found that X rays to a woman who was not pregnant could lead to damage in future offspring...

...Gore's action was rare...

...The health of radiologists declined dramatically with the expansion of their trade...

...Almost half the dentists repeated X rays of the mouth at least once a year...

...Many medical practitioners use X-ray machines extensively in their practices without even rudimentary training in radiology...

...Irwin Bross and Leslie Blu-menson of Buffalo's Roswell Park Memorial Laboratory soon estimated that, based on dosage levels, twice as many deaths as cures could result from mammographic screenings...

...Throughout the 1950s thousands of children and adults were even allowed to have their feet X-rayed in shoe stores to determine their proper size...

...An X-ray picture of a fetus in utero had been secured as early as 1896, and it had become common practice to use X rays to detect multiple births or abnormal conditions in the uterus, and to clarify the outlines of the mother's pelvis to aid in delivery...

...In 1980, some $6.7 billion was spent on radiology equipment, insurance, and personnel...

...Large amounts of radium, as a source of gamma rays, have been used to treat lupus, eczema, psoriasis, and other skin diseases, and to remove benign skin tumors and moles...

...In August 1976 the National Cancer Institute set interim guidelines for X rays at the screening centers, warning that "we cannot recommend the routine use of mammography in screening [women without demonstrable symptoms] ages thirty-five to fifty...

...Though lead "bibs" have been recently introduced to protect patients in some dentists' offices, sensitive organs such as the thyroid, salivary glands, active bone marrow, and lymphatics are still being exposed...

...Karl Z. Morgan, founder of the profession of radiation health physics, has stated, "If you ask many of these doctors what is a roentgen or a rad, they are not even able to give you the definition...

...An equal number of healthy mothers and children were used as controls...

...To become certified radiologists, doctors generally complete a three-year residency following their medical school training and internship...

...I think we need to face up not only to the long-term effects on the individual of exposure to radiation," she warned, "but on the long-term affects to the species...

...The National Cancer Institute, which supported the survey for a decade, put two of Brass's best-known opponents on its review committee...

...A 1976 telephone survey of 500 New York dentists by the New York Public Interest Research Group found that 89 per cent included a complete set of full-mouth X rays during a patient's first visit...

...As the demand for X rays expanded, so did the number of people operating the machines...

...to learn how to use the equipment...

...In 1977, the Federal Government recommended that women below the age of fifty be X-rayed only if they or a member of their immediate family had breast cancer...

...But she continued her work, and in 1958, with an expanded data base, she concluded that a fetus exposed in the first three months of development was ten times more likely to develop cancer than an unexposed fetus...

...Current estimates indicate that pelvic X rays are still given in about 6 per cent of all live births in the United States, though some facilities administer them at a far higher rate...

...Gore decided not to allow the X ray to be taken...

...At 1980 hearings for radiation victims, held in Washington, Karl Morgan remembered how he and others had "fought for years to pass a recommendation . . . that women in the childbearing age should not be given X rays in the pelvic and abdominal region except during emergency situations and except during the ten-day interval following the beginning of menstruation...

...Within weeks he was notified that Federal funding for his work on the Tri-State Survey was being terminated...

...Unfortunately, radiologists are not the only people administering X rays...

...In January 1975, Dr...

...At the time their study was issued, it was generally believed that the "threshold" below which radiation exposure was safe was roughly ten rads...

...As of 1981, fewer than a third of the states required licensing of X-ray machine operators, and even those regulatory programs are by no means uniform...

...The X rays could even penetrate walls and irradiate people in other rooms...

...The danger can be heightened by the subject's genetic makeup, preexisting benign breast disease, artjficial menopause, obesity, and hormonal imbalances...

...In 1963, MacMahon told a Joint Committee on Atomic Energy hearing on bomb fallout in southern Utah that "we must consider very seriously the possibility of cancer production by low doses of radiation such as encountered in X-ray diagnosis and even fallout...

...Though the dose to the bone is much lower—four millirems—a full mouth series can involve sixteen or more individual X-ray films and can deliver a substantial dose of radiation to the mouth...

...But the program took on the aura of a fad...

...A 1976 telephone survey by the New York Public Interest Research Group indicated that women of childbearing age who underwent X-ray examinations were generally not asked beforehand if they were pregnant...

...Surgical therapy...

...The first thing the doctor said," Gore recalled, "was, 'Let's have an X ray.' " Gore asked the doctor if the pillow stuffing would show up on the X ray...

...Machine operators often tested their equipment by placing their hands—time and again—in the beam...

...As an elite group of medical doctors with radiation training, they raised the use of diagnostic X rays to the status of a high-powered medical specialty...

...Representative Bob Eckhardt, chairman of the House Subcommittee on Oversight and Investigations, found it "particularly disturbing, if not outright frightening...

...Bross warned that "the irresponsible or incompetent use of X ray" could not be stopped if health agencies waited for the medical profession to give the word...

...Silent Death The misuse of medical X rays BY ELEANOR WALTERS WITH HARVEY WASSERMAN When Congressional hearings on medical and dental X rays were held in 1979, Representative Albert Gore, Tennessee Democrat, recalled taking his young daughter to a hospital emergency room after she had inhaled some pillow stuffing...

...In the 1950s, many children and adults were subjected to X-ray hazards to determine what size shoes they should buy Rosalie Bertell, in examining the data, added that "young people with asthmas, severe allergies, heart disease, arthritis, and so on, were about twelve times as susceptible to radiation damage as were healthy children...

...In 9 per cent of these cases—involving more than 7,000 individuals^—the fetus was exposed to the X-ray beam...

...Copyright © 1982 by Harvey Wasserman and Norman Solomon...

...Gore then asked why an X ray was necessary...

...Many were told to experiment on their patient and to try different techniques...

...Children in utero have not been the only ones to suffer from the misuse of X-ray technology...

...The doctor said it would not...

...The risk for radiation-induced breast cancer is higher than for all other radiation-induced cancers, including thyroid, lung, leukemia, and bone tumors...

...But because the breast is highly radiation-sensitive, the mammogram itself can cause cancer...

...The program included instruction in breast self-examination, an initial clinical history, and a physical examination which included a thermogram (which uses an infrared camera to study body temperatures) and a mammogram X ray...

...Known as the Tri-State Survey, the study covered some thirteen million subjects in New York, Maryland, and Minnesota who had undergone diagnostic X rays...

...About 300,000 people are currently employed operating medical and dental X-ray equipment...

...The failure of the X-ray industry to comply was, he said, "one of the biggest problems in reducing the harmful effects of radiation...

...Similar considerations apply to the overuse of dental X rays...

...Perhaps the technology most vulnerable to this kind of financial consideration is the new "computerized axial tomography scanning" machine—the CAT scanner...

...Daniel Donohue, president of the American Society of Radiologic Technologists, assisted in a training program and found that many prospective X-ray machine operators "were told never to adjust the controls of the equipment, but to increase the time of exposure when they X-rayed a larger patient...

...In 1896, Dr...

...E. B. Lewis found a significant excess of deaths from leukemia, multiple myeloma, and aplastic anemia among radiologists, and two years later two Johns Hopkins researchers discovered a 70 per cent excess of cardiovascular disease and certain cancers among radiologists as opposed to the general population, and a 730 per cent rise in leukemia deaths...

...In 1956, the National Academy of Sciences (NAS) supported those findings in a report that concluded that the lifespan of radiologists was 5.2 years shorter than that of other doctors...

...By early 1977, Bross had become an outspoken critic of the program, calling it a "disastrous mistake" that would "produce the worst...

...One major program of X-ray diagnosis— mammography, aimed at tracking down breast cancer in women—has also resulted in disaster...

...In 1973, the American Cancer Society and National Cancer Institute cosponsored the establishment of the Breast Cancer Detection Demonstration Projects (BCDDP...

...Scatter radiation may also affect other parts of the body, including the gonads, a particularly severe problem among children...

...that in many states any person can walk off the streets and operate machines which are capable of inflicting great harm upon those exposed to them...

...In the early 1960s one of the largest radiation-related population studies ever done was begun by Bross and Nachimuthu Na-tarajan of the Roswell Park Memorial Institute...

...The medical profession, she said, had accepted the word of the weapons industry about what doses of radiation were safe, and what were not...

...Rose Kushner, executive director of the Maryland-based Breast Cancer Advisory Center, told us that "women all over the country were inundated with information about this life-saving machine, and waiting lists for mammograms were often months long...

...A part-time machine demonstrator, H. D. Hawks, was forced to quit his job after only four days because his hands began to redden and swell...

...Hawks's problems were minor compared with those of Clarence Madison Dally, a glass blower at Thomas Edison's Menlo Park laboratory and the first American known to have died from X-ray exposure...

...When Stewart and Hewitt sifted through the data, they found that twice as many cancer deaths occurred before the age of ten among children whose mothers had received a series of pelvic X rays while pregnant...

...Trained as a pediatrician and epidemiologist, Stewart began crisscrossing Britain, persuading local health officials to interview the mothers of each of the 1,694 children who died of cancer the previous two years...

...Yet two decades after Stewart first published her findings, and fourteen years after MacMahon confirmed them, little had been done to warn the public...

...even a single X ray was found to contribute...

...In 1946, a statistical study of obituaries in the New England Journal of Medicine by Dr...

...Side effects were not long in surfacing...

...In the late 1970s, James L. Kline of Ha-gerstown, Maryland, suffered an overdose of radiation which was given him as a precaution after the surgical removal of his prostate gland...

...Said Brass, "We became the most recent victims of a pattern of censorship and repression that has been going on in the United States ever since the furor over fallout from weapons...

...But radiation as a medical treatment has often been misunderstood and abused...

...Nonetheless, the controversy continued...

...Problems arise when the technology is overused and when its dangers are not fully appreciated by the medical profession or the public...

...In 1962, the findings of Stewart's embattled study received powerful confirmation from Dr...

...A study of 700,000 children born between 1947 and 1964 was conducted in thirty-seven major maternity hospitals in the Northeast...

...The CAT scanner can be enormously useful—and also enormously expensive, costing up to $1 million to buy and $500,000 per year to maintain...

...She lost her staff and her funding for the Oxford survey...

...Omitted from this flood of media coverage, however, was the behind-the-scenes conflict among scientists about the potential danger of exposing healthy breasts to a known carcinogen: X ray...

...Is there a financial incentive for overuse of X rays...

...It contains an X-ray tube and an electronic detector situated on a circular track...

...A body scan can cost $250 (CAT radiation therapy can run as high as $36,000 per patient) and by the early 1980s more than two million Americans were undergoing CAT examinations each year...

...By the 1960s, mammography was in common use, and a study begun in 1963 by the Health Insurance Plan of New York (HIP) concluded that mammography could reduce mortality rates among women...

...At a meeting sponsored by the National Cancer Institute, Bross accused the American Cancer Society and the American College of Radiology of subjecting a quarter of a million American women to X-ray dosages equivalent "to death warrants with a fifteen-year delay in execution...

...The entire program was repeated each year for five years, with a five-year observation period after screening...

...In 1963, a study by Dr...

...Five years later a study of 68,000 single deliveries in sixteen hospitals during 1969 and 1970 estimated that pelvic X rays were given in 6.9 per cent of the cases...

...Injection of radioactive materials into some tumors and growths can reduce and destroy them...

...In 1979, Americans received more than 270 million individual X rays, constituting the largest single source of human-made penetrating radiation doses...

...It was quite by accident that we bumped into the radiation story," Stewart told us...

...Dr...

...As the technology was refined and the equipment became more powerful, increasingly serious damage was reported...

...There were also signs the X rays contributed to premature aging...

...With a growing number of early cancer patients, radiation therapy techniques are emerging that are as viable now as radical therapy...

...A visual slice can be taken of any body part...

...It was a stunning confirmation of Stewart's findings, and made essentially inescapable the conclusion that the human fetus was far more vulnerable to miscarriage, malformations, and cancer from X rays than anyone had previously believed possible...

...Nor had there been a full accounting for what X rays might be doing to the gene pool...

...Delacorte Press will publish the book in April...

...The medical establishment gradually responded to the criticism...

...Some, Donohue added, had been instructed "not to limit the beam of radiation in the area of interest, which is a basic control for radiation safety to the patient...

...Breast cancer is the leading cause of death among American women between the ages of forty-four and fifty-five...

...The "accident" was not well received by either the medical community or the nuclear industry...

...The risk increased with the number of exposures...

...Thus, she charged, "the doctors have abdicated responsibility in this area...

...He found that cancer mortality was 40 per cent higher among the children with X-rayed mothers...

...The skin on his knuckles disintegrated from overexposure, fingernail growth halted, and the hair on exposed skin fell out...

...In May 1977, the outspoken Bross co-authored an article in the Journal of the American Medical Association, blaming doctors for excess cancers and increased risks of genetic damage because of misuse of X rays...

...Genevieve Mantanowski, who is directing the continuation of the Johns Hopkins study, wrote that there is additional evidence that radiologists also suffer an increased risk of contracting multiple myeloma, and an increased chance of death from strokes and heart disease...

...There has also been some tragic fallout...

...Recent advances in radiation therapy allow the maximum potential cure with the minimum of side-effects, such as nausea, vomiting, skin reactions, and scarring," says Dr...

...In 1981, Dr...

...Rosalie Bertell, an expert in radiation and the causes of cancer, later explained that a basic arithmetical error had been made in the design of the mammography program, which may well have resulted in serious health effects to early participants...

...Luther W. Brady Jr., of Philadelphia's Hahnemann Medical College and Hospital...

...His preliminary statistics convinced Dr...

...Brian MacMahon of the Harvard School of Public Health...

...Great care must be taken to ensure that all the cancerous growth is destroyed and that none of the surrounding tissue is harmed...