Figure 3 - The Nasal Radium Irradiation "applicator" shown below was typically inserted through both nostrils and positioned at the rear of the nasopharynx at the opening of the Eustachian tube irradiating the adenoids for 12 minutes per treatment -A standard course of therapy consisted of 3 to 4 twelve minute "treatments", repeated as necessary.

Some individuals received dozens of "courses" of NRI therapy

The Radium Experiment Assessment Project [REAP] is a project of the Center for Atomic Radiation Studies, Inc. [CARS]. CARS/REAP is devoted to ethical actions regarding Nasal Radium Irradiation (NRI) to:

1) Promote public awareness of potential health risks of NRI, based on scientific studies completed to-date, and encourage "right-to-know" initiatives

2) Promote outreach to and identification of NRI treated individuals

3) Promote research and documentation of known facts of issue, and act as clearinghouse for making accurate information available to patients, their families, and any interested party

4) Provide individuals advice on documenting their individual exposure history and health status as input to possible epidemiological study

5) Promote proper medical surveillance and follow-up recommendations for NRI treated individuals based on present documented and sound scientific knowledge of NRI effects on health.

REAP will attempt to help people who have had Nasal Radium Irradiation (NRI) treatments from the 1940's-1970's in meeting each other, discussing issues of concern, and sharing information amongst themselves, and with the CARS/REAP staff of health physicists and lawyers.

Starting in late 1993, REAP's Director Stewart Farber began an intensive effort which resulted in a U.S. Senate Hearing on "Assessing the Effects of Nasal Radium Irradiation" (S. Hrg. 103-822, Aug. 29, 1994, broadcast live on C-Span) by the. Senate Committee on Environment and Public Works, Subcommitee on Clean Air and Nuclear Regulation. Since early 1994, the issue of experimental and "standard medical" use of NRI, and its effects on health has emerged from the dustbin of medical history. The US Centers for Disease Control [CDC] has been forced to evaluate this vital and significant public health issue due to the 1994 Senate Hearing (at which time it testified against any need for medical notice to treated individuals) and in 1995 following the Aug. 1994 Senate Hearing derived an estimate that between 571,000 and 2.6 million children in the general U.S. population received NRI treatments by the private sector for enlarged adenoids or tonsils from 1946 through 1961 alone. However, the CDC is still on record actively opposing any type of medical notice or follow-up recommendations to the general public by sticking to its position that there is "no significant neoplastic or other disease risk" from NRI.

The Radium Experiment Assessment Project [REAP] is a project of the Center For Atomic Radiation Studies, [CARS], a Massachusetts' based organization, first organized in 1984 to serve an educational role in providing accurate, unbiased information about radiation issues.

Radium Experiment Assessment Project
by Stewart Farber

Annotated Bibliography on Nasal Radium Irradiation (NRI) Health Risks and Evolution of Issue

Advisory Committee on Human Radiation Experiments --(ACHRE) Staff, "RE: Nasopharyngeal Radium Treatment", to the ACHRE, dated March 27, 1995(a) -(126 pages - memo plus 13 Attachments)- This memo was prepared in response to the letter dated March 8, 1995 by S. Farber [see Farber, 1995(a) ] which criticized the failure of the ACHRE to review the experimental use of nasal radium irradiation (NRI) on 7,613 military veterans during 1944-45, which he initially brought to their attention in July 1994. This memo was described by the ACHRE staff as a "capsule description of the issue as Staff presently understands it" for a planned discussion of NRI treatments by the ACHRE at the April 1995 Committee public meeting. This public discussion was tabled for several meetings until very late in the ACHRE deliberations at which time it could no longer ignore the issue.

This March 27, 1995 ACHRE staff memo, with one major exception, became the source of the final text of the review of nasopharyngeal irradiation published in the Final ACHRE report [(See ACHRE, 1995(b). The exception was a statement by Dr. Eli Glatstein, one of 14 members of the ACHRE. Dr. Glatstein, the most experienced radiation oncologist on the ACHRE, who as Chair of the Department of Radiation Oncology, University of Texas, Southwestern Medical Center at Dallas at the time (and who was formerly Chief of Staff of Radiation Oncology at NCI/NIH) wrote in this memo that medical monitoring of military personnel given nasopharyngeal radium treatments is a must:

"I think there is no question that these individuals need to be monitored. I am not sure we can 'protect their health', but they should be monitored to see if there is any substantive problem that results from their exposure."

However, nothing about Dr. Glatstein's recommendation related to notice or follow-up of NRI experimentally treated veterans (or children) was included in the Final ACHRE report issued on Oct. 3, 1995 (see ACHRE, 1995(b).

Advisory Committee on Human Radiation Experiments - ACHRE Final Report - October 1995(b) - (includes a total of 16 pages related to NRI) - Buried within the body of this unindexed 925 page report issued to the President on October 3, 1995 is a scattered and error filled discussion (vs. ACHRE's own limited cancer mortality risk calculations) and several recommendations related to NRI treatments -- included in Chapter 7 (Nontherapeutic Research on Children), Chapter 18 (Recommendations) and Part IV (Addendum to Rec. 4: Medical Notification And Follow-Up"). Per the ACHRE:

"For the children who received nasopharyngeal radium treatments, the Advisory Committee has estimated that the lifetime risk of [SAF NOTE: this was a calcuation of deaths from neoplasms] tumors to the central nervous system (brain), head, and neck regions is approximately 4.35/1,000 ...."

[NOTE: THIS IS A SUBSTANTIAL ERROR BY THE ACHRE IN CITING ITS' OWN RISK CALCULATIONS AS CONTAINED IN THE FINAL REPORT TO PRESIDENT CLINTON] -The probability of an individual dying of brain cancer over the lifetime of an exposed individual was calculated by the ACHRE as 4.35/1,000. ACHRE's calculated risk for cancer mortality from cancers of the brain, head and neck due to NRI was actually 8.4/1000- The Baltimore schoolchildren treated with Nasal Radium Irradiation by Johns Hopkins in the human radiation experiment reviewed by ACHRE had the highest calculated risk to each treated individual of any of the 4,000 experiments examined for which people were still alive and might benefit from notice and follow-up and represented the only human radiation experiment to exceed the 1 per 1,000 "risk" or mortality rate pre-selected by ACHRE.

The Final ACHRE Report stated: "However, at greatest risk are the brain, and head, and neck tissues, for which there is neither an accepted nor recommended screening procedure. Thus, while the subjects in these experiments meet the Advisory committee's arbitrary 1/1,000 criterion for consideration for notification and medical follow-up, the utility of such a program has not been demonstrated, ...Therefore, the Advisory Committee does not recommend notification and medical follow-up of children or adults in this group of experiments." ACHRE also stated that there was no reason to provide medical notice to any child treated in the Johns Hopkins human radiation experiment with NRI because as they put it: "most of the risk has probably already been expressed.". What this sentence really means, since the risk being considered by ACHRE is cancer mortality, is that ACHRE is making a completely unsupported and self-serving claim for the US Government which funded Johns Hopkins as to perform the "human radiation" experiment, that in the ACHRE's opinion anyone who was going to die from NRI would have died as of 1995 from the 1948 -1954 experiment!! Therefore nothing need be done to notify surviving members of this experiment as to the need for future health screenings for conditions linked to the experimental treatment, or the families of deceased members involved in the experiment in question. This is an ethically obscene, and amazingly word-engineered statement designed to divorce the reader's understanding of the statement from its meaning, as well as being a scientifically flawed claim. In other words, according to the ACHRE if a human medical experiment is performed and in the extreme case even 100% of the experimental test subjects died within a few years [before the issue were reviewed for by some group of experts like the ACHRE Committee whose goal expressed in the ACHRE charter was "to right the wrongs of the past", and whose Chairperson was Dr. Ruth Faden, a supposedly respected bio-ethicist on faculty at Johns Hopkins which performed the radiation experiment in question] the government agency or medical institution which conducted the human radiation experiment bears absolutely no responsibility for the death of test subjects. THIS IS AN OUTRAGEOUS, AND INDEFENSIBLE, CLAIM BASED ON SCIENTIFIC FRAUD AND A VIOLATION OF EVERY BASIC TENET OF BIO-ETHICS IN HUMAN RESEARCH!!

Note that none of Dr. Glatstein's comments included in the March 27, 1995 memo [see ACHRE 1995(a)] from the ACHRE staff to the ACHRE were quoted in the final report. Dr. Glatstein candidly admitted in response to a direct question from REAP's Stewart Farber as to his written views vs. the Final ACHRE Report, that he was outvoted by the other 13 ACHRE panel members in preparing final recommendations not to notify the thousands of individuals who were subject to human radiation experimental NRI treatments of the risk of brain cancer and the need for notification and follow-up. Dr. Glatstein stated to REAP in a phone conversation just before the final ACHRE Report to President Clinton was issued on Oct. 5, 1995, that the basis of the ACHRE "recommendation" [to do nothing] regarding NRI risk was that any action aimed at notifying thousands of NRI experimental subjects was: "not salable in today's political environment". [Personal communication, Dr. Eli Glatstein to Stewart Farber, Sept. 18, 1995]. This decision to do nothing was neither a medical nor an ethical decision, but a decision based on what Dr. Glatstein himself termed "political" considerations apparently aimed at avoiding embarrassment and perhaps economic impacts on potentially responsible governmental bureaucracies and involved medical institutions like Johns Hopkins Hospital, and practitioners. It is noteworthy that Dr. Ruth Faden, Chair of the Advisory Committee on Human Radiation Experiments, and a professor of bioethics in the Johns Hopkins School of Public Health failed to recuse herself from a vote on the Nasal Radium Irradiation experiment conducted by her employer even though, under the circumstances, this represented a serious ethical breach on her part.

Annals of Otology, Rhinology, and Laryngology, [Hendricks, J.E., et. al.], "The Use of Radium in the Aerotitis Control Program of the Army Air Forces", Vol. 54, pp. 650-724, 1945 - "A Combined Report by the [Army ENT physician] Officers Participating" describing the initial experimental use of nasal radium on a total of 6,881 Army Air Force crew during 1944-45 in the Third, Eighth, 12th, 15th, and 112th Air Forces.

Brody, J.E., "Brain Tumors: More Curable But More Numerous", New York Times, July 5, 1995

Committee on Environment and Public Works U.S. Senate "Assessing the Effects of Nasal Radium Treatments", Full transcript of Hearing before the Subcommittee on Clean Air and Nuclear Regulation, (S. Hrg. 103-822), (127 pages), August 29, 1994 - This hearing was held as a result of information brought to Sen. Joseph Lieberman's (D-CT) attention by S. Farber in Jan. 1994 and interactions by REAP's S. Farber with Lieberman aide Dr. Murray Hitzman. This information concerned at least 5,000 submariners treated with NRI in Groton, CT by the Navy and many thousands of members of the public treated in Connecticut by a former Navy ENT physician, who went into private practice in New London, CT after developing the radium treatment for the Navy. The over 2 hour hearing was broadcast live on C-Span. Despite this hearing, the DOD and VA refused until Sept. 1997 to notify any exposed veterans of the potential for harm [at which time 42 vets out of 20,000 treated veterans were notified] or initiate any study of potential health risks faced by nasal radium exposed veterans. A Videotape of the Aughst 1995 US Senate hearing is also available from CSPAN. Call for information

Executive Order 12891, The White House, Office of Press Secretary, (3 pages), Jan.18, 1994 - This order established the Advisory Committee on Human Radiation Experiments (ACHRE) to provide advice and recommendations on the ethical and scientific standards applicable to human radiation experiments carried out, or sponsored, by the U.S. government. The ACHRE was forced to evaluate use of nasal radium on veterans and children as a "human radiation experiment" [see Farber, 1995(a)].

Farber, S., and Ducatman, A.M., "Radium Exposure in U.S. Military Personnel, The New England Journal of Medicine, Vol. 326, No. 1, pp. 71-72, Jan. 2, 1992. - This letter describes the nasal radium procedure and brought to the attention of the medical and scientific communities information that at least 5,000 treated submariners faced a risk for a variety health problems (including malignant head and neck tumors) based on epidemiological studies cited. It called for a central registry and the establishment of a "formal program for the identification and medical surveillance of such people" by the US Navy. The Navy (in its reply published with this letter) wrote the radium treated vets had a "right to privacy" not a "right to know" and claimed the risks were "relatively small". The Navy position was based on an internal review paper (see Warlick, 1991 below) obtained through the intervention of U.S. Senator Chafee, former Secretary of the Navy in early 1994, responding to an inquiry from S. Farber.

Farber, S., Letter to Department of Energy, Radiation (EH-1) Hotline, RE: Radium Exposure to Nasopharynx -Cohort of 5,000 ex-Navy submariners treated from WW II through 1966, (29 pages), Jan. 17, 1994(a) - This letter documents radiation doses received from NRI procedure, suggested excess health risk, basis for conducting an expanded epidemiological study, need for a formal program for identification and medical surveillance of radium treated veterans, provides copies of "Public Service Bulletin" medical advisories to treated members of public and "Announcement for Physicians" to medical profession on nasal radium irradiation concerns related to NRI issued in 1977, warnings regarding NRI risk voiced by ENT specialists at a medical conference in 1949, need for Government pressure to perform an epidemiological study of Navy submariner cohort, and early news coverage of issue.

Farber, S., "Assessing the Effects of Nasal Radium Treatment", Invited Testimony presented at a Hearing of the U.S. Senate Committee on Environment and Public Works, Subcommittee on Clean Air and Nuclear Regulation, (S. Hrg. 103-822), Aug. 29, 1994(b), (22 pages) - Includes background on the evolution of the issue, evidence of excess health effects related to benign and malignant tumors of head and neck (5.3 fold excess) and thyrotoxicosis (Graves disorder, 8.6 fold excess), early warnings regarding nasopharyngeal irradiation, and questions why the research completed in 1979 suggesting both elevated cancer rates and thyroid problems was never followed up.

The appendix to this written testimony reviews the scientific literature documenting that nasal radium irradiation effects on health due to excess brain cancer mortality risk alone (per the National Academy of Sciences, Biological Effects of Ionizing Radiation BEIR-V risk factor derived from the Sandler, 1982 published paper in the Journal of the National Cancer Institute with an Abstract calling the increase in brain cancer "small") would exceed the excess cancers from all causes occurring among an equal sized cohort of A-bomb survivors of Hiroshima and Nagasaki. It was this analysis which led to Senate Hearing 103-822 having been organized by Sen. Lieberman after he wrote the President on July 20, 1994 (copy of Press Release (2 pages) included, U.S. Sen. Lieberman Press Office: "Lieberman Urges President to Order Study of Radium Treatments --Senator Says New Evidence Describes Experimental Nature of Treatments; Data Indicates Abnormal Cancer Rate", Press Release-7/20/94)

Farber, S., Letter to Advisory Committee on Human Radiation Experiments (Wash., D.C., dated March 8, 1995(a), "RE: Nasopharyngeal Radium Experiments Performed by DOD on 7,613 Navy and Army Air Force Military Personnel during 1944-45", (11 pages), including Appendix I - "Estimation of Radium Nasal Irradiation Health Effects in Military Experimental Cohort" - This letter finally forced the ACHRE to evaluate nasal radium irradiation on both military personnel and children (studied under an NIH grant to Johns Hopkins Hospitals from 1948-53) as a "human radiation experiment". Also includes news article: "Committee ignoring radium tests on troops, physicist says", Albuquerque Tribune, March 13, 1995 which noted criticism by S. Farber that the committee's "lack of consideration of this high-risk group appears to highlight an inconsistent and illogical approach to the mission of the advisory committee.". A July 1994 letter by U.S. Senator Lieberman written to President Clinton requesting that nasal radium irradiation experiments on these veterans during 1944-45 be formally reviewed by the ACHRE as an experiment had been ignored. Only after this March 8, 1995 letter presented detailed, unambiguous documentation of the facts did the ACHRE cease its attempt to ignore what was finally judged to be the most significant human radiation experiment of any of the 4,000 "experiments" it reviewed for which people were still alive and might benefit from notification and follow-up.

Farber, S., Letter to U.S. Senator John Chafee (R-RI) dated March 27, 1995(b), RE: Human Radiation Experiments Issue: Determination by US Navy That Initial Use of Radium on Submariners was a "Human Radiation Experiment" (including a copy of Internal Navy Memo dated Feb. 23, 1994 from the Submarine base commander in New London to the US Navy Bureau of Medicine and Surgery admitting that initial use of NRI on submariners was a "human radiation experiment" --This memo while initially referenced in drafts of the ACHRE Report on Human Radiation Experiments, was deliberately deleted from the final report to President Clinton)in a section titled Contrary Information Provided to Senator Chafee by Navy, (17 pages), - - This letter was sent to Sen. Chafee due to his having assumed Chairmanship of the Senate Environment and Public Works Committee following the Aug. 29, 1994 Senate Hearing on the health effects of NRI chaired by Sen. Lieberman. This letter asked for an investigation of both the Navy Deputy Surgeon General and the Acting Surgeon General of the Air Force having provided false testimony about initial use of NRI on veterans being "standard medical practice" rather than "human radiation experiments" before this Senate Subcommittee Hearing held on Aug. 29, 1994(see transcript of S. Hrg. 103-822 for documentation of inaccurate statements on this key point by Navy Surgeon General Koenig and Air Force Surgeon General Buethe).

Farber, S., "Assessing the Effects of Nasal Radium Treatment", - Published in the Health Physics Society (HPS) Newsletter, June 1995(c)- (2 pages) This Commentary points out that: "Radium nasal irradiation ..had been essentially overlooked or deliberately ignored by cognizant governmental bureaucracies, and the medical/scientific community....The US Government has failed to behave in an honest and ethical manner regarding....its obligations to evaluate all human radiation experiments under Executive Order 12891 establishing the ACHRE" and that "any further failure to act indicts the entire process by which radiation risks to the general population are monitored and responded to by the Federal government and responsible medical institutions."

Farber, S., "Assessing the Effects of Nasal Radium Irradiation Treatments - Is a Forgotten Medical Procedure a Massive and Risky 'Human Radiation Experiment' and a Domestic 'Nagasaki Up the Nose'?, 1995(d), (30 pages), Presented at the Annual Joint Meeting of the Health Physics Society (HPS) and the American Association of Physicists in Medicine (AAPM), Works-In-Progress Poster Session", Boston, MA, July 23-27, 1995 - This poster became the basis for the Medical News & Perspectives Feature article in the Journal of the American Medical Association (see Skolnick, 1995), "Government is in No Rush to Study Thousands of Veterans Who Received Nasal Radiation Therapy)".

Farber, S., "Evolution of Nasal Radium Issue - What's Wrong with the Process by Which Radiation Risks are Investigated?" (29 pages), Invited presentation at "The Public Health Response to Nasopharyngeal Radium Irradiation: A Workshop" [keyed to Handout Packet provided to VA/Durham Regional Medical Education Center prior to workshop] sponsored by the U.S. Centers for Disease Control (CDC)/ U.S. Veterans Administration (VA). Presented Sept. 27, 1995(e) - The NRI Workshop coordinator, Yale University School of Public Health, failed to reproduce and censored the distribuion of any of the handouts submitted by S. Farber to the VA's Medical Education Center for reproduction and distribution to attendees as routinely required of a medical education accredited (ACCME) Workshop organizer. These handouts suppressed by the Workshop organizers included: 1) S. Farber's U.S. Senate Subcommittee testimony (see Farber, 1994 (b); 2) the March 8, 1995 letter by Farber to the ACHRE which forced review of the use of nasal radium as a "human radiation experiment" (see Farber, 1995(a)); 3) the March 27, 1995 letter to U.S. Sen. John Chafee transmitting a copy of an internal Navy memo dated Feb. 23, 1994 documenting that initial use of nasal radium on submariners was a "Human Radiation Experiment" (see Farber, 1995(b)), a fact contradicted in Senate testimony by the Navy's Deputy Surgeon General (see Committee on Environment and Public Works, 1994) at which the Navy (and Air Force) Surgeon Generals falsely testified that all use of nasal radium on submariners (and aviators) was "standard clinical practice"

Farber, S., "Nasal Radium Irradiation and the Advisory Committee on Human Radiation Experiments - A Failure of Process: Bad Science/ Bad Medicine/ Bad Ethics" Invited Testimony presented at a Hearing of the U.S. Senate Committee on Governmental Affairs, US Senate, "Human Radiation Experiments" (S. Hrg. 104-588), -March 12, 1996(a) This testimony can be viewed by clicking on the following link: US Senate Testimony of S. Farber on Failure of Process and is one of the links noted on the REAP webpage

Farber, S., "Nasopharyngeal Radium Irradiation - Scientific, Medical, and Governmental Imperatives for Identification and Surveillance of Treated Individuals, Invited presentation to 1996 American Nuclear Society/European Nuclear Society Annual Meeting, Embedded Topical Session on Low-Level Radiation Health Effects, Washington, DC, Nov. 12, 1996(b)

Gordon, Danielle, "The Verdict: No Harm, No Foul", the Bulletin of the Atomic Scientists, Vol. 52, No. 1, Jan/Feb 1996 This article provides a broad overview of the Oct. 1995 issued Advisory Committee on Human Radiation Experiments Final Report, including prominent mention of NRI risks as reviewed by the ACHRE. It notes that per the review by ACHRE, NRI treatment of 3rd grade children in Baltimore by Johns Hopkins was the only human radiation experiment of 4,000 reviewed by ACHRE in reviewing 840,000 pages of documents to exceed the ACHRE threshhold for medical notice and follow-up. However, ACHRE in a widely criticized set of excuses for its failure to recommend medical notice and follow-up on NRI treated children came up with various flawed excused to do nothing. As noted in the Bulletin of the Atomic Scientists' article:

The committee concluded that to be eligible for medical notification from the government, a person must have an increased lifetime risk of dying from radiation-induced cancer of more than one in 1,000 (compared to the normal lifetime risk of 220 per 1,000).

But these subjects should not be notified because, according to the committee, they would not benefit medically from early detection and treatment of their cancers: "At greatest risk are the brain, and head, and neck tissues, for which there is neither an acceptable nor recommended screening procedure." [NOTE by S. Farber: This is a completely false statement that is not supported by the references cited by ACHRE in its Final Report -see Farber, 1996(a) for detailed critique] Thus, the committee concluded there was "no subject of biomedical experiments for whom there is a need to provide active notification and medical follow-up for the purpose of protecting their health." Click here for link to this Bulletin of the Atomic Scientists Feature article

Haines, H.L., and Harris, J.D., "Aerotitis Media in Submariners", Annals of Otology, Rhinology, and Laryngology, Vol. 55, (24 pages), 1946 -- This journal publication documents in the open medical literature that initial use of nasal radium on 732 submariners during 1944-45 was a carefully designed "human radiation experiment". As stated by the lead author: "The present report describes aerotitis media as it appears in submariners, and recounts the experiments by which we attempted to understand it and mitigate its effects."

Keough, Bob, "Worse than the disease?", Boston Sunday Globe Feature Article, Jan. 31, 1999 Click here for link to this Boston Globe Magazine feature story

This article describes the use of Nasal Radium Irradiation on children and veterans. The procedure, which had fallen into the dustbin of medical history, was used to shrink hypertrophied adenoids and tonsils in an estimated 570,000 to 2.6 million young children [per 1995 CDC estimates] from post WW. II. through 1961 alone. NRI treatments involved the insertion of 50 mg Ra-226 sources, encased in 0.3 mm Monel to maximize beta dose in the first cm of tissue, with doses falling off sharply with distance from the source. During WW. II, NRI was used in human experiments on no fewer than 7,613 Army Air Force crew members and submariner trainees [per published reports in the open medical literature] to treat pressure equalization problems. Doses to the nasopharynx [for the standard post-W.W.II protocol used on children involving three, 12 minute irradiations, applied bilaterally] are calculated at no less than 2,000 rad on contact [see Farber,1992 - see Annotated bibliography at REAP web site], although measurements made using the Monel metal radium applicators observed a contact dose of about 13,000 rad in a routine course of therapy. Thyroid doses to the youngest children treated from direct radiation were stated by Sandler, 1980 as being up to 100 rad. Doses to the pituitary gland of young children was about 50 to 100 rads while the BEIR-V Report estimated brain doses of from 15 to 40 rad with Relative Risk= 5.3 for brain cancer mortality in NRI treated children per Sander, 1982, in a study of 904 children [for which it was able to track 667] who received NRI treatments at a Johns Hopkins hearing loss clinic in Hagerstown, MD followed for 24 years. This was based on 3 brain cancer deaths vs. 0.57 expected, and was statistically significant at the p=0.01 level meaning there was only 1 chance in 100 a difference this large could be due to chance.

Land, C.E., "Carcinogenic effects of radiation on the human digestive tract and other organs", (31 pages) from Radiation Carcinogenesis, A.C. Upton, R.E. Albert, F.J. Burns, and R.E. Shore, Eds. New York, Elsevier Press, 1986 - This document was cited by the BEIR-V Report (see National Research Council, 1990) as the basis document for the excess brain cancer risk (5.3 fold higher rate) derived from the Sandler, 1982 publication of neoplasms in children from nasal radium irradiation.

Lieberman, Sen. Joseph, "Senator Lieberman's Position on Nasal Radium Treatments in the US Military", 1998

This summary statement from Senator Lieberman's web page focuses mainly on the use of NRI in the military particularly Navy submariners in Groton, CT and the discovery of a logbook in April 1996 listing the names of submariners treated during a human radiation experiment, the existance of which had previously been denied by the Navy. It provides some history to Sen. Lieberman's interests and significant efforts regarding NRI risks to health beginning in January 1994 when the issue was brought to his attention by Stewart Farber leading to the Senator convening a US Senate Environment and Public Works Hearing on Aug. 29, 1994 titled "Assessing the Effects of Nasal Radium Treatments" [see: >Committee on Environment and Public Works U.S. Senate "Assessing the Effects of Nasal Radium Treatments", 1994]. Sen. Lieberman deserves credit for his many efforts to advance public outreach and education for both medical doctors and former patients. This summary contains a number of technical errors due mainly to the errors in the CDC published statements on the NRI issue, such as repeating an error that "An additional study of a larger populaation published in .....1989 [see Verduijn, 1989] did not document a statistically significant increase in head and neck cancers in the exposed group." The 1989 Verduijn study did not report a statistically significant increase in head and neck cancer mortality, but the Verduijn, 1996 study report on the same group of children [as reported in the CDC proceedings of the 1995 Workshop organized by the CDC and VA, but conspicuously ignored in all statements by the CDC and VA] represented by his 1989 study, reported a statistically significant doubling of overall cancer incidence, mostly in the head and neck. Accordingly, responsibility for this important misstatement about the conclusions of the Verduijn, 1989 and Verduijn, 1996 studies of a large population treated with about 30% of the radiation dose typically used in the US, lies with the CDC and VA and not with Sen. Lieberman's office.
Click here to see "Nasal Radium Treatments in the US Military"

Maremont, Mark, Staff reporter to Wall Street Journal, "One Crusader's Effort to Publicize A Health Risk Finds Little Success", July 26, 1999 -This front page feature article focused more on the personal cost and family impacts of Stewart Farber's many years of efforts to force government and medical attention to the health effects of NRI and reach out to NRI treated individuals with prudent health advisories. This article contains several inaccurate statements downplaying the risks of NRI and ignoring the findings of recent epidemiological studies [See Verduijn, 1996 and Yeh, 1997], and in Stewart sharing in any judgements in any class-action suits [vs. providing professional consulting services only as an expert witness vs. Maremont's having written that "he might eventually get ....even a small share of the lawyer's take from any winning suits" which was completely erroneous}. Click here to see this Wall Street Journal Feature article

Matanoski, G.M., Research Grant Summary: "Health Consequences of Nasopharyngeal Radium Exposure", (2 pages), appearing in "Research Into the Biological Effects of Ionizing Radiation in the Bureau of Radiological Health, U.S. Dept. HHS, Public Health Service, Food and Drug Administration, Bureau of Radiological Health, HHS Publication (FDA) 80-8125, dated July 1980. States there was an overall statistically significant increase in benign and malignant tumors of the head and neck among irradiated patients compared to the non-irradiated.

Mellinger-Birdsong, A.K, "Estimates of numbers of civilians treated with nasopharyngeal radium irradiation in the United States", Otolaryngology -Head and Neck Surgery, Vol. 115, No. 1, pp. 429-432, Nov. 1996 -Derives an estimated number of people treated with NRI from 1945 to 1961 [treatment however extended well into the 1970s in certain areas like Maryland where the procedure was extraordinarily entrenced due to so many physicians there having trained at or been influence by Johns Hopkins Hospital and Medical School] of 571,000 to 2.6 million persons

National Cancer Institute [NCI], Division of Cancer Control and Rehabilitation, "Information for Physicians, Irradiation-Related Thyroid Cancer", U.S. Dept. of Health, Education, and Welfare, Public Health Service, National Institutes of Health (NIH), DHEW Publication No. (NIH) 77-1120, 1977- This true "consensus standard" issued jointly by NIH/NCI recommends that for any person treated with "unusual head and neck irradiation" including NRI, a recall notice issued by the hospital or treating physician to perform an initial thorough head and neck exam and follow-up exams every 2 years for the rest of a person's life. The US Centers for Disease Control and Johns Hopkins in their recent statements to the mendical community and the public have totally ignored this NIH/NCI Advisory which is the most definitive review of what, at a minimum, should be done to provide medical follow-up to this special population at risk.

National Research Council, National Academy of Sciences, Committee on the Biological Effects of Ionizing Radiation, "Health Effects of Exposure to Low Levels of Ionizing Radiation" (Biological Effects of Ionizing Radiation (BEIR) -V Report), Washington, DC, 1990, (3 page excerpt), "Radiogenic Cancer at Specific Sites: Brain and Nervous System" - The National Academy of Sciences based on the Sandler, 1982 study derived the excess brain cancer risk (5.3 fold excess) for nasal radium irradiation of children

Radium Experiment Assessment Project[REAP]--News Release: "582 Baltimore Schoolchildren in Human Radiation Experiment by Johns Hopkins Found by Government to Have Cancer Risk 10 Times That of Thousands of Similarly Treated Veterans Proposed for Priority Medical Care by VA - Baltimore Experimental Subjects Ignored by Government --Central Registry Announced .....To Evaluate Risk of 'Nasal Radium Irradiation'", dated August 6, 1997

This is a detailed News Release about the shortcomings of the Advisory Committee on Human Radiation Experiments [ACHRE] to deal with a group of schoolchildren treated in a human radiation experiment by Johns Hopkins despite the level of risk found by ACHRE, the failure of the March, 1997 federal Human Radiation Interagency Working Group [IWG] Action Report [ironically titled: "Building Public Trust: Actions to Respond to the Report of the Advisory Committee on Human Radiation Experiments"] to even mention this Johns Hopkins NRI experiment on children despite this one experiment having the highest risk to health of any of the 4,000 experiments examined by ACHRE [see Appendix 1 of the REAP Aug. 6, 1997 News Release for details], and the complete illogic and ethical breach of the federal IWG Action report recommending medical followup for NRI treated veterans while ignoring children at a 10 times higher risk of excess cancer mortality per the ACHRE's own risk estimates. There are three detailed Appendices to this News Release as described below. For a full copy of this 11 page News Release see:
Click here for full copy of REAP News Release on Baltimore Human Radiation Experiment Conducted by Johns Hopkins

Rath, Mollie, "Old Cure, New Ills", [Baltimore] City Paper, Nov. 5, 1997 - This is an in-depth investigative review/news article about the NRI issue with specific focus on Baltimore and Johns Hopkins. A link to it is on the REAP Webpage at the bottom of the page, or by clicking on the following link: Click here for Baltimore City Paper Article

Robinson, Melissa, "Thousands concerned about radium treatments", AP Wire Story, October 1997 - This story describes steps in progress to qualify veterans treated with nasal radium for priority medical care, but highlights the government ignoring "as many as 2 million civilians who received the same treatments for ear infections." Cites an estimate that 67,000 Maryland residents received nasal radium irradiation and human radiation experiments conducted on Baltimore schoolchildren by Johns Hopkins starting in 1948. Click here for link to this AP wire newstory

Robinson, Melissa, "Federal Government does little for civilians suffering radium's effects", AP National Wire Story, April 17, 1999 This is a recent update on the failure of the US Centers for Disease Control to recommend medical notice and follow-up screening recommendations to the NRI population at risk based on this agencie's inaccurate, and incomplete review of the medical literature.

Click here for link to this AP update newstory

Robinson, Melissa, "Private Scientist Faults VA Over Radium Study", AP National Wire Story, August 9, 1999 This article notes the release by the VA in late July, 1999 [following a feature article in the Wall St. Journal on NRI which noted the existence of the VA report -- see Maremont, 1999] of a health effects study of submariners treated experimentally with NRI in Project X-434 in 1945. "The VA study compared deaths among 1,214 submariners who had the [NRI] treatment vs. deaths in a control group of 3,176 randomly selected veterans who were not treated. The VA claims to have found a 47 percent increased risk of deaths from head and neck cancers in submariners who were treated, as well as a higher, overall death rate." The VA claimed however, the excess risk was "not statistically significant". However, as noted in this article, Stewart Farber of REAP pointed out that the study greatly underestimated the likely excess risk of adverse health effects in NRI treated submariners because only 432 of the 1,214 men who the VA claimed as having received radium, actually had an "R" notation by their names in the study logbook maintained at the time of the experiment, indicating that the men actually received NRI ["Radium" = R] treatments. This completely non-conservative assumption by the VA invalidates their conclusions as to the 47% higher excess risk of head and neck cancer, and it being not statitistically significant, except to make it highly likely the true adverse effect of NRI on the 444 submariners documented as truly having received NRI, is far higher than the VA estimated.

Click here for link to this AP newstory

Sandler, D.P, Matanoski, G.M., Comstock, G.W., and Mitchell, T, "Health Consequences of Nasopharyngeal Radium Exposure", The Johns Hopkins University, School of Hygiene and Public Health, (10 pages), appearing in "Symposium on Biological Effects, Imaging Techniques, and Dosimetry of Ionizing Radiations, held Rockville, MD, June 6-8, 1979, U.S. Dept. HHS, Public Health Service, Food and Drug Administration, Bureau of Radiological Health, HHS Publication (FDA) 80-8126, dated July 1980 - This published report based on Sandler's presentation at the noted scientific symposium presents overall health risk findings by Sandler, et. al, never published in the open medical literature, that documents an 8.6 fold excess of thyrotoxicosis (Graves disorder), a non-malignant thyroid condition normally considered autoimmune in origin. This highly statistically significant excess of thyrotoxicosis may be due to intense irradiation of the pituitary gland resulting in hormonal imbalance or other mechanisms due to even higher doses delivered to adenoidal lymphoid tissues. The SUMMARY of this document states that:

---The published report on Sandler's Ph.D. research (see Sandler, 1982) narrowed its subject matter to neoplasms only, so as to exclude discussion of the high and very statistically significant excess rate of Graves disorder in the NRI treated population.

Sandler, D.P., Comstock, G.W, and Matanoski, G.M., "Neoplasms Following Childhood Radium Irradiation of the Nasopharynx, Journal of the National Cancer Institute, Vol. 68, pp. 3-8, 1982 - This final published "peer reviewed" journal article on the Sandler Ph.D. study health effects findings represents the only long term follow-up of NRI as practiced in the US up until the publication 15 years later of the Yeh, 1997 Ph.D. thesis whose findings have been kept from the public by Johns Hopkins School of Public Health. Because this 1982 Journal article changed its title from "Health Consequences of NRI .... to "Neoplasms Following Childhood Irradiation....", no mention was made of the very elevated rate of Graves disorder in this journal article as noted in the (Sandler, 1980) presentation. The 5.3 fold excess of brain cancer documented by the National Academy of Sciences (National Research Council, 1990) synthesis of the Sander, 1982 study related to excess brain cancer risk was described in the lead ABSTRACT to this paper as follows: "Whereas no one [emphasis added by S. Farber] head and neck site showed a statistically significant excess, a slight excess of brain cancer occurred 15- 20 years after radium treatment." [Comment by S. Farber: The Johns Hopkins School of Public Health affiliated author's of this paper appear to have deliberately sought to minimize the impact of their research findings on the reader, and prevent full comprehension of the research's significance by describing a rate of brain cancer mortality 5.3 times normal, per the National Academy of Sciences, a 430% increase in the nasal radium treated study group as "slight". Also earlier scientific papers by Sandler (See Sandler, 1980) had noted that combining all head and neck cancers in the NRI treated group was the more correct way to judge overall health impacts from NRI due to the relatively small sample size of their study vs. merely looking to document a statistically significant excess at each "individual site". By combining all head and neck tumors as recommended by Sandler, 1980 there was a statistically significant doubling of head and neck tumors in the NRI treated group. The Sandler, 1982 paper's published Abstract appears to attempt to divorce words regarding the research findings from their meaning and significance to the population at risk. George Orwell must be rolling over in his grave!]

Skolnick, A., "Government is in No Rush to Study Thousands of Veterans Who Received Nasal Radiation Therapy", Journal of the American Medical Association, Vol. 274, No. 11, p 858-859, Sept. 20, 1995. This article, based upon a Poster session on NRI by REAP's S. Farber presented at the 1995 Annual Meeting of the Health Physics Society, was written by JAMA's Medical News and Perspectives Sr. Editor. This article traces the evolution of the nasal radium issue, the evidence for health effects, the importance of establishing a central registry of exposed individuals, the need for recommending medical surveillance of exposed individuals, recent interactions with the Advisory Committee on Human Radiation Experiments by S. Farber, and the failures of the U.S. Government to act in an honest and ethical manner to follow up on the issue.

Skolnick, A., "Discovery of 50-Year Old Naval Logbook May Aid Follow-Up Study of Radium-Exposed Veterans", Journal of the American Medical Association, Medical News and Perspectives Feature Article, Vol. 276, No. 20, p 1628, 1630, Nov. 27, 1996

Sugg, D., "Treatment linked to cancer risk - Hopkins pioneered method - But U.S. board recommends against notification", The (Baltimore) Sun, October 4, 1995

Sugg, D., "Old cure, new ills", The (Baltimore) Sun, October 13,1997 Article notes that: "Millions received nasal radium therapy in 1940s, '50s and '60s; Higher cancer risk studied; VA seeks to warn vets, but more civilians underwent treatment"

This is a fairly detailed article about the background and present status of NRI treatments developed at Johns Hopkins. The article is based on a News Release issued by REAP dated August 6, 1997 criticizing actions by the Clinton Administration that children treated experimentally by Johns Hopkins were totally ignored in the March 1997 Report by the Interagency Working Group [IWG - the Cabinet Secretaries of all federal agencies involved in human radiation experiments]. The IWG in March 1997 recommended that NRI treated veterans receive priority medical care from the VA, even though the cancer risk to NRI treated children was 10 fold higher according to the ACHRE report, than the risk to NRI treated veterans, and ACHRE had claimed the vets deserved no consideration since their cancer risk did not exceed the risk criterion of 1 death from cancer per 1,000 treated individuals. Children treated with NRI were estimated to have a cancer mortality risk by ACHRE of 8.4 per 1,000 individuals, or about 10 times higher than treated vets but were completely ignored in a clear attempt to avoid having to deal with the issue which may affect more than 2,000,000 individuals treated with NRI as children. This article reviews case studies of several Maryland residents who had made contact with REAP, and highlights the work of REAP to prompt medical notice and follow-up recommendations by the US Centers for Disease Control and Johns Hopkins. Click here to see this Baltimore Sun Feature article

US Government, Interagency Working Group on Human Radiation Experiments, "Building Public Trust: Actions to Respond to the Report of the Advisory Committee on Human Radiation Experiments" (DOE/EH-0532), March 1997 -The White House released this report detailing the Clinton Administration's planned actions in response to the Advisory Committee on Human Radiation Experiments (ACHRE) 1995 Final Report recommendations on Cold War-era radiation experiments. ACHRE's recommendations and their implementation by the Human Radiation Interagency Working Group (IWG) this report were claimed by the Administration to detail the steps the US Government would take to finally "right the wrongs of the past inflicted on unknowing citizens". The 4,000 human radiation experiments reviewed by ACHRE were carried out or funded by the U.S. Government primarily through the Department of Defense (DOD) and Department of Energy (DOE, or its predecessor agencies) and were conducted at numerous major medical institutions, including Johns Hopkins Hospital. The experiment most conspicuous by its absence from the Clinton Administration's Implementing Report involved 582 third graders in the Baltimore public schools who were part of a 1948- 1954 experiment conducted by Johns Hopkins to test the effects of Nasal Radium Irradiation. Overlooking the Johns Hopkins NRI experiment in question as to any medical notice or follow-up action by the federal government, despite ACHRE's earlier determination that children in this Hopkins radiation experiment had the greatest cancer mortality risk of any experiment it examined for which people were still alive and might benefit from medical notice and follow-up, is a glaring failure of process. The Administration has proposed in this report that 7,600 veterans treated in NRI experiments reviewed by ACHRE be declared eligible for health screening under the Department of Veterans Affairs' Ionizing Radiation Program, but children at higher risk treated in Baltimore were not even mentioned in the Action Report. The Hopkins experiment has major public health implications to the no less than 571,000 children and young adults estimated by the U.S. Centers for Disease Control to have received NRI nationwide as late as the 1960s as 'standard medical practice'.

US Preventive Services Task Force, Guide To Clinical Preventive Services- An Assessment Of The Effectiveness Of 169 Interventions (Baltimore; Williams & Wilkins), 1989 - ACHRE in making a false claim that "there is neither an accepted nor recommended screening procedure"[for cancers of the brain, head, and neck tissues] cites this document as the basis for such a claim. Careful review of this ACHRE referenced document shows it contradicts this claim by ACHRE as to the lack of "utility of notification and medical follow-up" for NRI treated experimental subjects. This document does not specifically mention recommendations on "cancers of the brain, head, or neck" given that it was restricted to more common health interventions only. The closest it comes to any health problem of the brain, head, or neck is that it does include a section on screening that relates to NRI thyroid health concerns in its Section 17, "Screening for Thyroid Disease "(pp. 105-110). The Thyroid Disease section's summary of the 1989 US Preventive Services Task Force, Guide To Clinical Preventive Services RECOMMENDATIONS contains the following:

"Persons with a history of upper-body irradiation may benefit from regular physical examination of the thyroid." [p. 105]

Verduijn, PG, Hayes, RB, et.al., "Mortality after nasopharyngeal radium irradiation for eustachian tube dysfunction", Annals Otology, Rhinology, Laryngology, Vol. 98, pp. 839-44, 1989.- This study which has been widely cited by the VA, DOD, and CDC as "contradicting" the Sandler, 1982 publication only reported excess cancer mortality findings in children treated with average radium doses 3.5 times lower than used in the U.S. on average. See Verduijn, 1996 below for an update on a doubling of excess cancer incidence in the Dutch cohort.

Verduijn, P.G., "Late health effects of radiation for eustachian tube dysfunction: Previous results and ongoing study in The Netherlands", Otolaryngology -Head and Neck Surgery, Vol. 115, No. 1, pp. 417-421, Nov. 1996 - This recently published epidemiological study reports findings as to excess cancer incidence which were ignored by the Human Radiation Experiments Interagency Working Group in its recent Implementing Report issued by the White House. The Verduijn, 1996 report noted: "A statistically significant difference was noted..... for cumulative all-site cancer incidence with the exposed having twice as many verified cancers as the nonexposed." This study, the largest epidemiological study ever conducted of the effects of NRI on the health of treated children, followed 2,510 NRI treated children in the Netherlands who received average radiation exposure 3.5 times lower than received on average in children treated with NRI in the Hopkins experimental programs.

Warlick, Steven B., CDR, MC, USN, "Nasopharyngeal Irradiation with Radium: Its Use in U.S. Submarines and a Review of the Literature", June 6, 1991 -(40 pages) Internal review paper prepared for the Department of the Navy, Bureau of Medicine and Surgery, Washington, DC. (obtained in March 1994 through the intervention of Sen. John Chafee on behalf of S. Farber) as the supposed technical basis for Dept. of the Navy comments included in a response to Letter-to-the-Editor, New England Journal of Medicine by Farber and Ducatman (see Farber, 1992). This review concludes based on a selective (and often inaccurate) review of the scientific literature and an incorrectly researched history of the use of nasal radium by the Navy in the Submarine service that:

"There is neither anecdotal nor well-controlled evidence that this procedure is associated with or causes the later development of cancer. As is the case in many discussions about low-dose radiation [emphasis added - contact doses to nasopharynx at 2,000 Rem, were anything but 'low-dose'], concern over a carcinogenic role is difficult to assuage. Nevertheless, there does not seem to be any basis for attempting to identify or contact previously treated submariners because of a risk of cancer from irradiation..."

Yeh, Hsien-chieh, "Health Effects After Childhood Nasopharyngeal Radium Irradiation" - UMI Accession Number 9821222. Copyright 1997, submitted to the School of Hygiene and Public Health of the Johns Hopkins University in conformity with the requirements for the degree of Doctor of Philosophy, Baltimore, MD; (June 1997)

Follwing publication on July 26, 1999 of a front page feature article in the Wall Street Journal about Nasal Radium Irradiation [see Maremont, 1999] and the release of a new study by the VA's Environmental Epidemiology Service which found excess head and neck cancer [47% higher than controls] and overall mortality [26% higher than controls]in submariner veterans treated with NRI in a human-radiation experiment by the Dept. of the Navy in 1945 by Dr. Henry Haines [see Kang, 1999], Johns Hopkins School of Public Health suddently declared the Yeh, 1997 Ph.D. Thesis to be "RESTRICTED ACCESS ONLY - AVAILABLE ONLY WITH PERMISSION OF AUTHOR" AND ATTEMPTED TO RECALL ALL OUTSTANDING COPIES SOLD PREVIOUSLY BY UMI Dissertation Services of Ann Arbor, MI, a private company, at 800-521-0600, Accession Number 9821222. A full copy of this thesis was purchased by REAP in September, 1998 from UMI. A recall of a thesis more than 2 years after it was submitted and the degree awarded is a very suspecious action. The thesis contains some quite startling evidence of statistically significant long-term harm to children treated with NRI by Johns Hopkins, with the effects continuing right up to the recent past. It appears obvious that Johns Hopkins is trying to prevent the public from seeing the magnitude of the health effects from Nasal Radium Irradiation documented in their most recent research by Yeh, or the documentation that health effects are continuing to present themselves on the population at risk. This action by Johns Hopkins to restrict access to this thesis is also illegal under federal law, since the research was funded in part with federal monies.

Zappa, Frank [with Peter Occhiogrosso}, "The Real Frank Zappa Book" , Poseidon Press, 1989. "ZAPPA GETS ZAPPED" - Frank Zappa of the rock group Mothers of Invention mentions that he was born Dec. 21, 1940 in Baltimore, and grew up in Maryland. As a young child he lived in a row home in Park Heights Avenue in Baltimore, before moving to California at age 10. Zappa makes passing reference to his having received Nasal Radium Irradiation as a child in Baltimore when he writes:

"Along with my earaches and asthma, I had sinus trouble. There was some 'new treatment' for this ailment being discussed in the neighborhood. It involved stuffing radium [emphasis in original] into your sinus cavities. (Have you ever heard of this?) My parents took me to yet another Italian doctor, and, although I didn't know what they were going to do to me, it didn't sound like it was going to be too much fun. The doctor had a long wire thing -- maybe a foot or more, and on the end was a pellet or radium. He stuffed it up my nose and into my sinus cavities on both sides. (I should probably check to see if my handkerchief is glowing in the dark.)

This autobiography was written before Zappa took ill with prostate cancer some time later. Zappa died in 1993 at age 53 of prostate cancer, according to his official website: www.zappa.com. Prostate cancer has not been observed to be elevated due to NRI in the two US studies by Sandler, 1980 or Yeh, 1997 of about 600 children treated by Johns Hopkins in Hagerstown, MD. However, the research conducted by Verduijn, 1996 on a much larger cohort of about 2,000 children treated in the Netherlands with NRI which was published [and subsequently ignored in any Summaries of the Workshop by the CDC and VA] as part of the CDC/VA Yale Workshop proceedings, notes that there appears to be a statistically significant excess [roughly a doubling per Verduijn] of cancer incidence [cases vs. deaths] in NRI treated children, including urogenital cancer.