Newspaper snafu broadsides nuclear medicine

It was every doctor's nightmare: a five-part investigative newspaperseries on medical blunders. In emotional prose dripping with descriptionsof "horrible deaths," "hospital cover-ups"and "government laxity," two reporters from the ClevelandPlain Dealer chronicled what they claimed were decades of treatmenterrors in nuclear medicine and radiation therapy.

But the articles demonstrated that doctors are not the onlyprofessionals who err. Throughout the series the reporters confusednuclear medicine with radiation therapy, occasionally using theterms interchangeably. Readers were left with the impression thatthe disfiguring and sometimes fatal burns caused by radiationtherapy mistakes were the result of nuclear medicine procedures.It was a journalistic foul-up that has nuclear medicine specialistsconducting damage control.

"They got (nuclear medicine) all mixed up with radiationtherapy," said Dr. Carol S. Marcus, director of the nuclearmedicine outpatient clinic at Harbor-UCLA Medical Center in Torrance,CA, who was quoted in the series. "It was terrible."

The articles, which were published in mid-December, are notexpected to have a long-term effect on public perception of nuclearmedicine. They have, however, prompted federal legislators tocall for hearings to investigate the issue of radiation misadministrationerrors, giving nuclear medicine representatives the grim prospectof facing their profession's version of the Clarence Thomas/AnitaHill hearings.

Many of the incidents described in the series were chillingexamples of medical mistakes. The vast majority of these incidentsoccurred in radiation therapy, although nuclear medicine radiotraceroverdose stories were also related.

In one incident, the newspaper said 28 people died after receivingradiation overdoses during radiation therapy procedures at RiversideMethodist Hospital in Columbus, OH, in the 1970s. At least 40people have died since 1975 because of medical overdoses of radiation,the newspaper claimed.

But in addition to garbling terminology, the articles failedto present an adequate case for the benefits of both nuclear medicineand radiation therapy, according to Dr. James M. Moorefield, presidentof the American College of Radiology.

"The episodes were obviously tragedies," Moorefieldsaid. "They were very poignant examples of what can happen.But if one considers the number of radiation therapy proceduresdone in the U.S. each year it becomes infinitesimally small interms of a problem."

The rate of misadministration--when a patient receives an overdose,underdose or unintended dose of radiation--is 0.03% annually fortherapeutic procedures, according to the U.S. Nuclear RegulatoryCommission. The misadministration rate is even lower for diagnosticprocedures, according to the NRC.

Much of the Plain Dealer series focused on the NRC, which overseesmedical use of radioactive materials, claiming that the federalagency has failed to adequately regulate nuclear medicine andradiation therapy. According to the series, the NRC's recordsof radiation misadministrations are incomplete, it fails to levyadequate fines on doctors and hospitals who violate regulations,and it is generally too cozy with the industry it is supposedto regulate. Plain Dealer editorials called for increased governmentoversight of nuclear medicine and radiation therapy.

Few nuclear medicine specialists would argue with the contentionthat the NRC's regulatory track record in medicine has been lessthan stellar. But most believe that the tort system and professionallicensing boards are better guarantors of patient safety thanlarger fines, improved bookkeeping and more government reviewof medical outcomes.

"In any area of medicine, an agency is not responsiblefor how medicine is practiced," said Kristen D.W. Morris,director of government relations for the Society of Nuclear Medicineand the American College of Nuclear Physicians. "There'sno way a regulation could ever conceive of the variables involvedin any kind of treatment."

A more effective regulatory strategy would be for the NRC toadopt a practice certification program similar to the qualityassurance program developed in mammography, Morris said.

The upcoming federal hearings will provide nuclear medicineproponents with a chance to clear the discipline's name, as wellas to propose methods for improving the NRC's regulation of nuclearmedicine in ways that don't impinge on physician independence.Sen. John Glenn (D-OH) and Rep. Michael Synar (D-OK) have announcedthat they will hold hearings in the Senate and the House of Representativesin the next several months on the NRC's medical licensing program.

The NRC is also conducting reviews of its licensing programin response to the series, according to an agency spokesperson.

Ironically, some of the confusion over the difference betweennuclear medicine and radiation therapy may have originated atthe NRC itself. The Plain Dealer reporters relied on NRC representativesfor much of the information in the series. But the NRC spokespersoninterviewed by SCAN was not aware that nuclear medicine and radiationtherapy are separate disciplines.

"You're going to have to tell me the difference,"the spokesperson said in response to a question about the PlainDealer mix-up.

Meanwhile, nuclear medicine is left to patch up the journalisticequivalent of a botched procedure. Despite scattered reports ofcanceled nuclear medicine appointments in the Cleveland area,long-term damage to the discipline is expected to be minimal.Radiation oncologists, however, may have a tougher row to hoe.

And what of the Plain Dealer reporters who started the brouhahain the first place? They've been notified of the mistake, accordingto Morris.

"They seemed to understand that there was a misconception,but they were not intending to do a retraction and they neverdid," Morris said.