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Nose Out

Tight Lid Kept on Study Linking Nasal-Radiation Treatment to Illness

By Michael Sachdev | Posted 8/25/1999

In June 1997 the Johns Hopkins School of Public Health awarded Hsin-Chieh Yeh a Ph.D. for her dissertation, "Health Effects After Childhood Nasopharyngeal Radium Irradiation." The paper explains the effects of nasal-radiation treatments, pioneered by Hopkins doctors, that were widely performed on children in the 20 years following World War II to treat chronic ear and sinus infections. Yeh's conclusion: People who received the treatment are 30.9 times more likely to get benign and malignant brain tumors, 14.4 times more likely to grow salivary-gland tumors, and 4.2 times more likely to suffer thyroid cancer than people who did not.

Yeh's thesis offers perhaps the fullest picture yet of the little-studied effects of nasopharyngeal radium irradiation (NRI), a treatment developed and popularized by Hopkins and performed on hundreds of thousands of children until it was abandoned in the 1960s. But two years after its approval, access to the thesis remains severely restricted.

Officials at Hopkins' Department of Epidemiology say they cannot release copies of Yeh's thesis without her permission because it awaits publication in a scientific journal later this year. Kathy Moore, spokesperson for Hopkins' School of Public Health, say Yeh is authorizing releases on a case-by-case basis, but Yeh did not return a reporter's calls seeking access to her study. An aide to Rep. Sam Gejdenson (D-Conn.) says his boss has to date been unable to obtain the report, and when City Paper tried to order the paper from Bell and Howell Information and Learning, a Michigan-based dissertation-distribution service, a sales representative said it was on restricted status. According to Stewart Farber, a Rhode Island public-health scientist who has been researching the nasal-radium issue since the early 1980s, Bell and Howell has even tried to recall copies already in circulation.

Farber says he got a copy of Yeh's work from the company in September 1998. But days after the Wall Street Journal published and article on the study this past July 26, Farber says, Bell and Howell contacted him and asked that he return his copy. (He refused, and he provided City Paper with a copy.)

Farber's Radium Experiment Assessment Project advocates for hundreds of people who had NRI as children and now blame it for ailments ranging from lost teeth and impotence to thyroid tumors and cancer ("Fair Treatment," CP, 11/5/97). Hopkins has long contended there is no conclusive evidence of increased health risks associated with nasal-radium treatment, and has resisted widespread notification of former treatment recipients on the grounds that it would cause unnecessary panic. To Farber, the school's failure to distribute Yeh's dissertation is an attempt to protect itself from blame. Yeh "is obviously under tremendous pressure by the powers that be to hide her findings," he says.

But Hopkins officials deny any motivation other than protecting Yeh's work before it is formally published. "Her findings are in no way being covered up," Moore says.

NRI grew out of work by Hopkins' Dr. Samuel Crowe, who discovered in the 1920s that irradiation could shrink swollen lymphoid tissue, curing everything from nasal infections to sore throats. Over the next 20 years, that discovery developed into the treatment, which involved inserting radium-tipped wands into patients' nostrils.

The wands were magic, curing everything from simple sinus infections to deafness caused by recurring ear, nose, and throat infections and inflammation. The federal Center for Disease Control estimates that between 500,000 and 2.5 million people, mostly children, received NRI. But in the 1960s, as awareness grew of the correlation between radiation exposure and cancer, radium treatments became less and less popular, and were finally used only to treat life-threatening ailments.

Until the completion of Yeh's work, only two studies on NRI had been completed, with conflicting results. A 1982 study by Hopkins' Dr. Dale Sandler found that NRI patients are 5.3 times more likely to develop brain tumors than people who did not receive nasal radiation. Sandler also reported a higher incidence of brain cancer among NRI patients. But in a 1989 study, Dutch researcher Dr. Peter Verduijn found no relationship between high cancer rates and NRI.

Farber says Hopkins has been "eager to quote Verduijn's 1989 findings" in assessing NRI risks, but he says the study is irrelevant to Hopkins' case because "the [radium] dose delivered to children in the Netherlands was 3.5 times lower than the average radium dose delivered by Johns Hopkins" at a Hagerstown clinic it ran from 1943 to 1960. Farber also notes that Verduijn reanalyzed his data in 1996, checking with the same patients he studied for the '89 report, and found a health risk. "The exposed group had twice as many verified malignant tumors as the nonexposed group," the Dutch researcher wrote in the later report. "A striking difference was found in the occurrence of head and neck tumors."

Farber calls Yeh's work the most comprehensive yet on NRI. "It's a smoking gun," he says.

Karen Infeld, a spokesperson for the Johns Hopkins Medical Institutions, says that despite Yeh's findings, the institution has not revised its earlier decision against blanket notification of people treated with NRI. "We can't make a judgment unless [Yeh's thesis] is [published]," she says. "Once the results are officially presented, we'll be making a decision about them."

The thesis has also attracted attention on Capitol Hill. George Gager, an aide for Rep. Gejdenson, says he is drafting a letter to Yeh on his boss' behalf. "The letter is asking for a copy of the study to be released to Congressman Gejdenson," Gager says. "This is a potential health hazard that could affect 2.5 million Americans."

Gager says he received NRI treatments for childhood nasal and ear infections from 1949 to 1963 while growing up near a Navy submarine base in Connecticut. "I probably had more treatments than anyone else around," he says. "I haven't had a problem with cancer, but I did have a problem with my thyroid and pituitary. It damn near ruined my life."

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