Department of Energy Oak Ridge Operations Facsimile Cover Sheet, Subject: Orins Hospital, Cancer Treatment Issues

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Department of Energy Oak Ridge Operations Ray Marble, Office of Congressional,Intergovernmental, Forre stal Building and Public Affairs, DOE/Headquarters 252-2773

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BY HOWARD L. RQSENBERG medical and scientific authorities relreal that these treatments ellollred into something quite different: e The Oak Ridge Institute, where mn known to Mary Sue Sexton, her son Dwayne was serving as part of a government experiment: He was helping to find the parameters of the radiation sickness syndrome-precisely how large a dose it would take to cause a ‘person to lose his appetite, get nauseous experiments on animals and humans. B) Leading authorities on radiation protection, and even rlie AEC ifseljin its review of these experiments, judged that the treatnlellts were Of little, if any, benefit to the patients. The lllall who Oversaw the experimcnts, hO\\’-

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ever, is today one of the government’s chief experts on the o The government doctors administering the treatments knew of other therapy techniques-using either different types of radiation exposure or chemotherapy-that were superior. At least in Dwayne Sexton’s case, the government scientists at Oak Ridge initially withheld these betterestablished cancer treatments. the nation. 1 0 The clinic facilities were “substandard” according to the government itself, 2nd the A E C eventually forced its own clinic to close down. o Patients did not offer their f i d y informed consent to be part of some experiments. And some patients, like Dwayne Sexton, were subjected to several different types of experiments. e Though the treatments were administered as cancer therapy, one primary purpose was to obtain data for the United States’ space ram on human reacToday Oak Ridge’s broad, main avenues are still lined with Army barracks, converted and refurbished as apartment buildings. T h e “downtown” area is a modern shopping center. The denizens of the “Energy Capital” are a curious m u of rural-tired hill people and scientists and technicians from around the world. One out of every 35 Oak Ridgers holds a Ph.D. degree-one of the highest per capita ratios in Clarence Lushbaugh arrived in 1963 to head the AEC sion.” A short, balding man with a combative personality, Lushbaugh likes to say he “grew up in the gutters” of Cincinnati, Ohio, where his name, name-you had to protect a name like Clarence.” Most of his friends now call him tude of his youth has not inellowed much in G5 years. The name plate behind visitors that he is the Educated at the University of Chicago, where he nautics and Space Adminis- gree, a P1i.D. in pathology tration, urgently needed and an M.B. in medicine, data on human sensitivity to Lushbaugh began his career radiation, and the cancer in 1S49 as a pathologist in patients who came through Los Alanios, New MexInstitute of Nuclear Studies He doubled as the governbecame the human guinea ment town’s coroner. In pigs who provided th; information. Animals had been the first to breach the boundaries of space. Dogs and chimpanzees and monkeys were metamorphosed into avian creatures, hurtling through the stratosphere atop rockets. Down below, scientists were wrestling with unanswered questions about how human beings would stand up to the effects of radiation. Nausea and vomiting caused by radiation sickness were possibly manageable ailments on the ground. But to an astronaut wearing an oxygen mask, they could prove fatal. Hard data on human radiosensitivity was vital to NASA. But who would volunteer to be exposed to potentially lethal doses of radiation? In Oak Ridge, Tennessee, a pathologist at the AEC‘s clinic, Clarence Lushbaugh, agrecd to search- - for some of the answers NASA wanted. Oak Ridge is called the “Energy Capital ofthe World” nowadavs. It I u s & to be known as the “A<omic City.” This was the town created by Uncle Sam to produce fuel for the Manhattan Project’s A-bombs during World War 11. Hidden in hollows amid rolling hills of black oak, massive factories for producing bomb-grade uranium rose up within a perirnetcr of total military security. The limestone ridges along the snaking Clinch River offered natural protection from air attack. Power from the Tennessee Valley Authority was in plentiful supply. 1963, Lushbaugh moved to rural Tennessee and became a member of the staff of the Oak Ridge Institute. topes and plenty of machinery, but we didn’t have a wllole lot of sick people because it was a rather young population.” Oak Ridge offered the same access to radioisotopes plus a large group of Tennesseans who were gratefui for frce medical attention at the A E C clinic. The Qak Ridge Institute had a mandate from the Atomic Energy Commission-which was then the governnlent agency charged with promoting nuclear energy-lo conduct research into the “beneficial applications of radiation.” Some significant achievements did come out of Oak Ridge’s clinic, including the development of a cobalt 60 (C-60) telelherapy machine, which served as a prototype for others now used in cancer therapy at hospitals across the counliy. Lushbaugh was teamed with eminent hcmatologist Gould ably the world-renowned expert in takirig care of peisons with radiation injurics,” Lushbaugh says modestly, “and I was the world-renowned expert at trying to figure out what went wrong at the autopsy table.” If someonc was acutely irradiated in an accident, no malter when or where, Andrcws was called in to give ineckal attention. His hunched figure was unmistakable-he was afflicted with extreme curvature of the spine. Andrcws was a compas-

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sinnclte and competent attendant to hi. lients, but whenevShortly after his arrival in Oak Ridge, Lushbaugh won a NASA dontract to conduct a retrospective analysis of the effects of radiation: a hunt for the point at which the syndrome symptoms appear. H e looked for clues in the medical charts of cancer patients who had been treated with radiotherapy. By the end of 1964, Lushbaugh had compiled at Sloan-Kettering UP ‘ an X-ray machine to spray their patients, but the 0, Ridgers thought that radiationemitting isotopes like C-60and cesium 137 (Ce-137) would be more flexible than a bulky machine. Lushbaugh explains it this way: “See, with an X-ray tube, you would put the person on the floor in the fetal position, with his knees drawn up, and you’d zap him from the right side with an X-ray machine and then you’d flip him over and , irradiate him from the other side.”The METBI facility was a tailed notes on reactions in the systematic manner of a spec ti ve ” study was needed. Oak Ridge was the ideal place for the study and Lushbaugh was the ideal choice to conduct it. By car efuI 1y mo nit o r iii g p atients during and after radiotherapy at the clinic, Lushbaugh and his associates could be on the lookout for syndrome symptoms and could correlate them with the exact dose of radia- -1 In 1960, the Oak Ridge clindiator. Built in a special wing of the tiny clinic, METBI was designed for experiments testing spray irradiation as a treatment for blood cancers. It was part of the Atomic Energy Commission’s effort to use its nuclear wares to find those Prior to World War 11, researchers at the Memorial SloanKettering Cancer Center in New York discovered that by spraying a leukemia victim’s total body with X-rays, the radiation could be used to depress the bone marrow and kill canccrous blood cells forming there. Then, during the war, scientists found that injections of radiophosphorus and severa1 nitrogen mustards could achieve essentially the same results at only a fraction of the cost. “In essence,” said one of W c ’ x were superseded by simpler and better techniques.” 1 1 i t r W n mustards,” he says, “and so they began hogging all t h ~ ~Patients with leukemia. ... Well, obviously, the r;~~li~~[ficrapistsand the whole damn field of radiologists were m’t Villg to put up with that. So they came along with a +!‘[c’~ll for doing the same things as the nitrogen mustards, ~ 1 1 ~ 1;I nc\v twist in the technique of spray irradiation. Doctors 1 \\‘hat they camc along with at Oak Ridge was METBIan ordinary chesl X-ray is are considered therapeutic in treating some cancers. But as w e will see in Dwayne Sexton’s case and tients in these experiments, the massive radiation doses were not only part of a treatment plan, but also a way of gathering data €or the space progran. The treatment of leukegan as soon as the facility was operational. Gould Andrews directed the clhbaugh monitored the cancer patients for sians of the syndrome. Many aspects of the syndrome we$ already known even then. The government’s handbook for the holocaust, The Effects of Nuclear Weapom, reports that “for doses between 200 and 1,ooO rads the probability of sumival is good at the lower end o€the range, but poor at lhe upper end. The initial syniptonls are similar to those common in radiation sickness . . . the larger the dose, the sooner will As part of the federally fiinded Oak Ridge Associated Universities-a consollium of 50 colleges and universities throughout the South-the AEC clinic had a ready-made network from which to draw patients. Doctors in the rural South regularly referred cancer patients to Oak Ridge. Among them were people suffeiing from Hodgkin’s diiease, chronic lymphocytic leukemia, chronic granulocytic Icukcmia, polycythemia i-ubra vera, idiopathic thrombocythemia and lymphosarcoma cell leukemia. The Oak Ridge researchers begall their study by exposing patients to 50 or 100 rads at a time in the METBI chamber at a rate of 1.5 rads per minute. According to an internal progress report written in 1970, doctors involved in the experiments apparently never really thought these large doses would benefit the patients much, but since the cancer victims would probably require radiotherapy anyway, the scientists at Oak Ridge hoped to obtain some of the syndrome data NASA wanted. “It was not our plan to evaluate the long-

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transfelredinto four syringes and ir’-*ted into C.K? ni Mary sue’s hips and arms. tant, but she was stoic about her discomfort. .lIiC: .Ill. hcr unconscious body and begnn counting the pU11C:Iui<\sounds in his legs and chest. On August 16 there was more surgery. A s m ~ l lincision was made in Mary Sue’s left thoracic duct just .i!xove the collarbone, and a tube was inserted. For fi\c ~1.1,sfluid drained through the tube into a plastic vacu11111 h g . This L‘Serum” was filtered and then injected into Dwayne. The doctors had hoped that Mary Sue’s healthy body would build up antibodies, which would destroy the leukemic cells injected into her. Then, the antibodies in h e r blood Serum could be used to fight the leukemic cells produced in Dwayne’s bone marrow. But by mid-November of 1965, it was clear that this experiment had failed. ays the Baltimore Cancer “But you just cannot d o those things in humans first contacted by Mother Jones agreed that it is simply unethical to inject cancer cells into a Dwayne’s case, it was dr her t already proven, were readily available at the time. Today, research into cancer therapies using antibodies is still under way at several facilities, including the National Cancer Institute. Yet even now, 16 years after Dwayne’s treatment, the experiments are conducted largely on laboratory animals and on human cancer cells in laboratory dishes. After the failure of the bone marrow transfer, the Oak Ridge Institute doctors belatedly began treating Dwayne Sexton with chemotherapy. The Oak Ridge researchers were collecting syndrome data in earnest at that time, but the MFTBI facility had its problems and limitations. In addition, the Oak Ridgers had a new theory they wanted to test: Could thcy alleviate some of the side effects of the therapy by using lower doses of radntion over days or even weeks of continuous exposure? By 1967, the AEC had financed the construction of a Rille Totill-BOdy Irradiator. The difference bctwten it and ME?‘B1 w;IS likc the difference between the Ritz and a and feel like thcy wcrc 0 1 1 wcation. Esccpt the LETUI chamber had no u )WS. LETBl was really two rooiiis, onc built within the othcr. The outer chambcr w;is coiwctc. Insidc, a smaller, wooden box was ccntrally positioiiccl. llctween the walls were eight cobalt 60 teletherapy in;icltiws. which created a radialion field that could aclniiiiistcr r k w s ;is low as 1.5 rads per hour. The radiation machincs ivcrc‘ operated and monitorcd remotely from an instrunicrit console located in an adjacent control room. The pancl also contained closed-circuit TI’ monitors, a communicatioiis svstcni linked to the chamber ally developed to study the vital functions of patients as they underwent these new radiation treatments. The 65-foot umbilical was used to search for syndronie technicians could watch for subtle chanscs in respiration that would indicate study had advanced to tllC point where the doctors knew a patient was about to get sick and vomit before the patient did. ber], the whole thing would turn off, and he’d go out and take a leak and go back in, and sorncbody would bring Lushbaugh was successful in coming up with data that helped determine how much radiation it took to induce the syndrome. But NASA still wanted 10 know whether milder symptoms of radiation sickness might reduce an astronaut’s ability to perform routinc tasks in space. A series of strategically placed mirrors ciiabled Mary Sue to watch Dwayne in the METBI chamber. He thumbcd a wcll-worn comic book contentedly while the machincs were turned on. Just four months shy of his scventh birtliday. Dwayne had become all-too-familiar with the routine of hospital lifc. Over three and a half ycars, he had spcnt countlcss days at the Oak Ridge clinic. Despite the fiiilure of the bone marrow transfcr, chemical therapies had kept his leukcmic cells in.reniissionuntil this new crisis. Mary Sue silently mumblcd a prayer. On Thanksgiving Eve 196s. blood had begun trickling from Dwayne’s nostrils and oozing from the back of his throat. Mary Sue could not from their home in Rohbins, Tenncssce. thc idunlinuni bcd. Thc o n l y hopc for prolonging his life. thc doctors Said. \V;is to depres fhaync’s bone niarrow with a

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range effectiveness of these relatively large individual doses,” Andrcws, Lushbaugh and their colleagues explained in the report. ‘‘This would have required establishing a total treatment plan with this technique, which we were not preThe scientists wanted to “be able to add or substitute other forms of treatment,” which is not surprising, in light of the fact that the doctors virtually admitted that the METBI exposures were riot even the best method of treating the cancer patierzfs ruitli radiation. “One should not infer from this study,” they wrote in acandid assessment of the experiment, “that we expected these individual or infrequently given exposures to produce better ent, we feel that some pattern of fractionated expotion in several treatments] probably offers a preferable What these large, single exposures in the METBI chamber did offer was the best opportunity to monitor for the radiation sickness syndrome. According to a report of the experiment . provided to …