The Flip Medley

ISOTOPES!

Lost in all the discussions about the effects of Iceland’s volcanic activity and how it is affecting people’s ability to travel across the Atlantic is the fact that it is affecting healthcare here in the USA.

The story is pretty straightforward: there are only a handful of places where we can acquire molybdenum-99 and technetium-99m which are used in nuclear medicine and medical imaging.

Fast Facts on Molybdenum-99 - Where Is It Made?

To get an idea as to how these isotopes are used, here’s a snippet from medpagetoday.com:

The technetium-99m is used in more than 16 million nuclear imaging procedures every year in the U.S. alone for, among other things, sentinel node biopsies in cancer surgery, bone scans, and staging cancer patients.

The interesting thing is that (as you can tell from the map), this material is not available domestically. Everyone wants to fight tooth and nail politically over drilling (or not drilling), or building more nuclear plants (or not), and reforming healthcare (or not). But it isn’t obvious how all of this is interrelated, and how, for example, our lack of domestic capability to produce isotopes from our own nuclear plants might compromise our ability to keep up with the needs of patients regardless of what our healthcare policies look like.

Now, for added drama, let’s have a volcanic eruption in Iceland that stalls flights to/from Europe.

Lava flow from the Icelandic volcano

Concurrently, let’s have an outage of the only Canadian nuclear reactor that produces these isotopes. Back to medpagetoday.com…

But the main source of supply for North America — the NRU reactor in Chalk River, Ontario — has been shut down since last May and isn’t expected back online until April at the earliest. (See Canadian Reactor Shutdown Slows Nuclear Medicine)

Meanwhile, one of the reactors that has been picking up the slack — the Petten facility in the Netherlands — is to shut down this week for six months of maintenance.

So far, clinicians have been “getting by,” according to Robert Atcher, PhD, of the University of New Mexico, who is past president of the Society of Nuclear Medicine and chairman of its isotope committee.

By the way, that article about the shortage was written *before* the Icelandic volcano erupted. So if it was a crisis before the eruption, imagine what it is like now…

So now you get scenes like the one in my doctor’s office — where people are being turned away because we lack a sufficient amount of material to actual treat patients.

Who needs death panels and bread lines when our existing (and currently, “unreformed”) system can still experience shortages like this? This problem would occur regardless of the system in place as long as we have a dependence on others for critical materials.

So, sure, people may not like have a nuclear reactor in their backyard, but you may notice that the United States of America does not produce any of it. Zip. Zilch. We’ve “outsourced” all of the production of this material to other countries, the closest of which is Canada. And while we have “connected the dots” to see how a dependence on foreign oil might be a fundamentally bad idea given that the states that produce that oil seem to harbor a lot of anti-American sentiment among their populace, and I have to wonder if everyone who is being a nimby might be a bit short-sighted. We need to make sure we are a self-sufficient state, and we need to balance the need to globalize with the ability to sustain ourselves should the geopolitical (or, as in this case, the environmental) landscape change. And we need to take a holistic view of these issues and stop letting partisans whip everyone in to a frothy rage over things that don’t compute when taken together.