White House Is Urged to Help States With Nuclear Plants Stockpile Thyroid Drug

December 7, 2009

By MATTHEW L. WALD

WASHINGTON — After the terrorist attacks of Sept. 11, 2001, Congress passed a law instructing the federal government to help states build bigger stocks of a simple, cheap drug to protect people near nuclear power plants in the event of an accident or terrorist attack.

But the 2002 law left a legal loophole allowing the White House to forgo distribution if officials found that there was a better way to prevent cancer than administering the thyroid drug, potassium iodide. And after years of delays, the Bush administration dropped the plan in 2007, saying evacuations would be a better alternative.

Now advocates are trying again, bargaining on a new administration that is re-examining Bush-era policies.

Last week, Representative Edward J. Markey, the Massachusetts Democrat who wrote the drug provision in the 2002 law, sent a letter to President Obama asking for a review of its fate. The White House said in a statement that it was reviewing the legislation and “the process used by the prior administration.”

In arguing for enforcement of the 2002 law, Mr. Markey cited lessons learned in 2005 from Hurricane Katrina.

“Despite advanced warning, state and local governments were unable to evacuate effectively, or provide adequate food and water to those who remained behind,” Mr. Markey said in a statement.

He argued that advance preparation would be more effective than waiting until after a disaster to act.

The federal government already helps the 31 states with commercial nuclear plants stock pills for people within 10 miles, and some states have already distributed them in that zone. The provision sought to extend that radius to 20 miles.

But John H. Marburger III, who was the director of the White House Office of Science and Technology Policy in the Bush administration and who wrote the policy that is now in force, said that the chances of a problem beyond the 10-mile radius were small, and that moving people who were directly in the path of the plume would be easier than distributing pills in advance.

And if some pills were pre-distributed in the area, people would be preoccupied with finding them rather than paying attention to whether they were in the path of the plume, which would be relatively narrow, Dr. Marburger said in a telephone interview.

Distributing them might also have a “misleading psychological effect,” he said, suggesting that the drug would protect against all health effects, rather than just the effect of radioactivity on the thyroid.

Some states offer the pills to all residents within 10 miles of a plant but find that most do not want them. Dr. Marburger said that some states were not doing a good job of making the pills available within 10 miles of a plant and that he had recommended improvements.

Potassium iodide is hard to find in bricks-and-mortar stores but is available on the Internet, without a prescription. Federal guidelines stress its importance for children and young adults, whose thyroid glands are most vulnerable to radioactive iodine.

A National Academy of Sciences study ordered by the 2002 law concluded that the drug “should be available to everyone at risk of significant health consequences from the accumulation of radioiodine in the thyroid.”

The study also recommended that distribution “be included in the planning for comprehensive radiological incident response programs.”

Dr. Marburger said, though, that the study did not refer to the situation of people beyond 10 miles.

The idea of stocking the pills is drawing renewed support from groups that supported it in the past. “This implementation is long overdue,” Dr. Helen Binns, chairwoman of the Council on Environmental Health at the American Academy of Pediatrics, said in a statement.

Her organization favors stocking potassium iodide in schools, day care centers and other places where children are often gathered, given that their thyroid glands would particularly be at risk.

Potassium iodide works by saturating the thyroid with iodine so that it cannot absorb any radioactive iodine that is released from a reactor. But it works only if administered before exposure to the radioactive iodine occurs, experts point out.

The government’s position on potassium iodide has flipped back and forth for three decades. After the Three Mile Island nuclear accident in March 1979, federal officials scrambled to find a pharmaceutical company that could produce it immediately. The drug was not used, however.

Champions of nuclear power argued that the chance of release of iodine was so small that distributing drugs in advance over a wide area would only undercut public confidence in the safety of nuclear power.

Speaking for the American Thyroid Association, Dr. Elizabeth Pearce, an endocrinologist at the Boston University School of Medicine, emphasized that stocks of the pills had to be on hand in the event of a nuclear incident. “There’s a fairly narrow time window for it to be effective,” she said.

Hurricane Katrina was “a superb example of why you need advance preparation on the ground,” she added.