Nuclear Medicine

Nuclear medicine is an important branch of the larger nuclear technology tree developed since the turn of the 20th century. Like the development of nuclear weapons, nuclear medicine’s advancement during the mid-20th century involved an integrated network of laboratories, scientists, and experiments. In fact, these two nuclear research efforts—nuclear weapons and nuclear medicine—were often one in the same, sharing findings, personnel, laboratories, and most relevantly, significant violations of medical ethics codes. As such, while modern medicine has benefited greatly from the contributions of nuclear medicine, the highly problematic ethical concerns that define its development provide reason for a more critical analysis.

Jeffrey E. Williams, "Donner Laboratory: The Birthplace of Nuclear Medicine," The Journal of Nuclear Medicine 40, no. 1 (1999): 3-16N, 18N, 20N.Nuclear medicine was first developed by John Lawrence after his brother, Ernest Lawrence, and M.S. Livingston invented a particle accelerator called the cyclotron on January 2, 1931 at the Berkeley Radiation Laboratory. John Lawrence began experimenting with methods of producing artificial radioactive isotopes, which he thereafter administered to patients for a variety of medical procedures. Approaching World War II, his work, along with the work of Berkeley Radiation Laboratory, became intertwined both scientifically and institutionally with the nuclear weapons research being conducted under the Manhattan Project. What began as a novel medical experimentation, whose applications were being preliminarily explored, transformed into a complex national nuclear program that failed to maintain ethical standards under the aggressive demands of military mobilization.

Henry N. Wagner, Jr., "Nuclear Medicine: 100 Years in the Making," The Journal of Nuclear Medicine 37, no. 10 (1996): 3-18N, 24N, 37N.In the mid-1930s, Ernest Lawrence recruited two new scientists to conduct nuclear research alongside him at Berkeley: Robert Stone and Joseph Hamilton. Their goal was to better understand the interaction between radioactive materials and biological organisms by conducting radiotracer experiments using elements such as iodine-131 and strontium-89 on animal and human test subjects. When the war began, Berkeley Radiation Laboratory signed a contract with the Chicago “Met” (Metallurgical) Laboratory to conduct experiments on the human metabolism of uranium. As a result, Hamilton was placed in charge of a new set of secret human radioactive experiments at Berkeley, and Stone was assigned as Director of Medical Studies at Met Lab.

Alice Buck, for the U.S. Department of Energy, The Atomic Energy Commission, July 1983, https://www.energy.gov/sites/prod/files/AEC%20History.pdf.Similarly, other nuclear medicine researchers were reassigned and repurposed to serve as the medical arm of the Manhattan Project at laboratories across the country. Medical researchers moved from one laboratory to another, often being reassigned, like in the case of Stone, or communicating via mail to share results, findings, and coordinate plans. Alongside the Berkeley Radiation Laboratory and the Met Lab, nuclear medicine research was coupled with weapons development at the Clinton Laboratory in Oak Ridge, Tennessee; the Rochester Medical Project in Rochester, New York; Hanford Engineers Works in Benton County, Washington; and Los Alamos Laboratory in Los Alamos, New Mexico. This joint nuclear medicine and weapons laboratory matrix collaborated in researching and understanding the effects of a still nascent field of nuclear technology on human test subjects.

William Moss and Roger Eckhardt, "The Human Plutonium Injection Experiments," Los Alamos Science 23 (1995): 177-233, https://library.lanl.gov/cgi-bin/getfile?00326640.pdf.Of utmost medical concern was the overwhelming exposure of thousands of workers to not-fully-understood radioactive materials. For example, plutonium was discovered in 1942 and almost immediately became subject to wide-scale weapons testing. Because of widespread exposure to what was only after realized to be extremely high amounts of radioactivity, medical experiments were rushed. Advisory Committee on Human Radiation Experiments (ACOHRE), The Human Radiation Experiments: Final Report of the Advisory Committee on Human Radiation Experiments (New York: Oxford University Press, 1996).Each laboratory played a distinct yet interconnected role in better understanding exposure-retention ratios and subsequent health effects of radioactive material; in this process ethical violations were rampant. Experiments were carried through on scores of human subjects, many if not most of whom were not even terminally ill as a justification for such harmful clandestine operations. Plutonium, uranium, and polonium were administered in many cases without the consent of patients and in some cases without the patient's understanding that they were participants in an experiment. Multiple medical researchers later have expressed that their concerns about the unethical practices of their work were dismissed and overruled. A specific study of nontherapeutic (experiments with no medical benefit) tests on children found that at least 37 such tests were conducted, of which 21 were funded by the federal government.

Advisory Committee on Human Radiation Experiments (ACOHRE), The Human Radiation Experiments: Final Report of the Advisory Committee on Human Radiation Experiments (New York: Oxford University Press, 1996).To revisit the Berkeley case as an example of such gross violations of medical ethics, Dr. Hamilton, under Robert Oppenheimer and the Manhattan Project’s leadership, oversaw an experiment that injected two adults and one child with plutonium “to evaluate possible hazards." One of the subjects was Albert Stevens, who was selected for an assumed intestinal cancer condition which was later confirmed to be a benign stomach ulcer. Upon attempting to move out of Berkeley, Dr. Hamilton asked to be allowed to pay Stevens $50 a month to stay and continue with the experiments and ended up allegedly arranging a similar agreement. This is but one of many cases involving unethical practices that defined the development of nuclear medicine. Subsequently, it is on the back of countless unethical experiments like this that the field of nuclear medicine was made mainstream during the postwar years.

Often the same Nobel Laureates and revered doctors that have been honored for their contributions to the advancement of nuclear medicine were the ones in charge of these unethical practices. Robert Stone (Met Lab) and Joseph Hamilton (Berkeley Radiation Lab) are celebrated as the first to successfully use an artificial radioisotope to diagnose medical conditions. Glenn Seaborg (both at Berkeley and Met Metallurgical Lab in Chicago) and Edwin McMillan (who collaborated deeply with Ernest Lawrence at Berkeley Radiation Lab) won Nobel Prizes in 1951 for tracing radioisotopes. The lineage of chemists, physicists, clinicians, and other scientists lauded directly or indirectly because of their work in nuclear medicine is long and ethically muddled.

Johns Hopkins Medicine,"Nuclear Medicine: What is Nuclear Medicine?" https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/nuclear-medicine.Today, after a troubled origin story, nuclear medicine has many applications that greatly contribute to both the effectiveness and accuracy of modern medicine. At the prevention stage, nuclear medicine in the form of tracers are used to measure nutrient intake in order to detect nutrient deficiencies, balance of diet, and likeness of future illness. At the diagnosis stage, radiopharmaceuticals, or radioactive isotopes, are administered to create detailed internal maps particularly useful for cardiovascular diseases and cancer detection. Also, X-rays, PET, and SPECT scans all use radioactivity to take vital images of human organs, tissues, and bones. Precise imaging has been a leading cause for more personalized medicine. Finally, in the treatment stage, radiotherapy or chemotherapy is the most common form of cancer treatment and its progress is measured by radiopharmaceuticals. 

Sources

Advisory Committee on Human Radiation Experiments (ACOHRE). The Human Radiation Experiments: Final Report of the Advisory Committee on Human Radiation Experiments. New York: Oxford University Press, 1996.

Buck, Alice, for the U.S. Department of Energy. The Atomic Energy Commission. July 1983. Accessed August 9, 2020.

Johns Hopkins Medicine. "Nuclear Medicine: What is Nuclear Medicine?" Accessed June 12, 2021.

Moss, William and Roger Eckhardt. "The Human Plutonium Injection Experiments." Los Alamos Science 23 (1995): 177-233. Accessed August 9, 2020.

Wagner, Henry N. Jr. "Nuclear Medicine: 100 Years in the Making." The Journal of Nuclear Medicine  37, no. 10 (1996): 3-18N, 24N, 37N.

Williams, Jeffrey E. "Donner Laboratory: The Birthplace of Nuclear Medicine." The Journal of Nuclear Medicine 40, no. 1 (1999): 3-16N, 18N, 20N.