For those most focused on Fukushima's human toll, there are several main sources of concern: the continuing radiation menace in the region's fields, crops and seafood; and TEPCO's recent admission that its reactors won't be under control until 2012 at best. These offer critical reminders that radioactive cesium is now Japan's public enemy No. 1.
Behind the confusing fog of rad, rem, becquerel and milliseivert statistics lurks the basic fact that the spread of cesium 137 was the deadliest legacy of Chernobyl and is now the gravest health threat facing eastern Japan. Moving through strong radiation fields like chest x-rays, US airport scanners or Fukushima reactor rubble is obviously hazardous, but time limited. Carrying the radiation source around inside you 24/7, however, poses an exponentially greater threat, especially when it's an aggressive ionizing radionuclide like cesium 137 with a half-life of 30 years.
Despite its meager eight-day half-life, iodine 121 somehow became the rock star of radiation reporting and always gets top billing when things slip out of control. People in affected areas routinely dose themselves with potassium iodide to protect against I-121 exposure, but they hear little and do nothing about the cesium 137 they absorb. Cesium levels are usually reported second, if at all, even though they pose far greater risks for children, farm communities and the public at large.
Spawned profusely in fission reactions, cesium 137 decays slowly, bioaccumulates rapidly, spews intense gamma rays and hitchhikes easily in water, air and food. Imbibed, inhaled or eaten, even a few atoms can stir up mutagenic havoc in the organs where they land. The US National Academy of Sciences apparently had cesium in mind when it announced in 2005 that the only safe radiation level for young people is absolutely none at all.
As Kanto/Tohoku parents are becoming aware, their children are now surrounded by unnaturally high cesium levels in local neighborhoods and schoolyards, which translate into incessant exposure and countless youth at risk.
There is a common proven purge for cesium 137 called Prussian Blue (PB), but Japan blocks access to it with a tangle of catch-22s. Doctors abroad are counseled to use PB as quickly as possible for any “known or suspected radiocesium contamination” and can use a relatively simple urine test to assess cesium levels. In Japan, however, doctors can't prescribe PB without a ¥10 million “whole body radiation counter,” but according to NHK (Japan Broadcasting Corporation) there was only one such machine in all of Fukushima as of June 2 and it can only process ten patients a day.
Finally and most curiously, the only company that Japan licenses to sell PB has no stock for sale in any case and says it probably won't have any until the end of the year.
Technically, the drug is called ferric hexacyanoferrate (II), which is chemist speak for insoluble drug grade Prussian Blue. It is purified from the ancient dyestuff and has emerged as the most powerful cesium remedy discovered to date.
The US Food and Drug Administration (FDA) and the Center for Disease Control (CDC) endorse PB as the safest fastest way to purge radioactive cesium from the body before it creates malignant cells. Both agencies urge doctors to use it as quickly as possible after exposure, and many people are already taking it to counter Fukushima cesium. Most of them live in California, however. You still can't beg, borrow or steal the drug where it's needed in Japan.
According to the CDC, PB has been used to flush out cesium and thallium since the sixties, and it became globally recognized after a 1987 mass cesium poisoning in Goiânia, Brazil. Hundreds were hospitalized, but a few grams of PB a day cut victims' internal contamination by over 70 percent in just a few weeks.
In 2003, the US Department of Health and Human Services issued a press release pleading for “New Drug Application Submissions for Prussian Blue as a Treatment for Radioactive Cesium Contamination” to boost national stockpiles of the drug in case of a “dirty bomb” attack. Their appeal notes the drug is the first and only FDA-approved treatment for internalized radioactive cesium and virtually begs for generic production stating, “Because the FDA has already completed the safety and efficacy review work, applicants need only submit the chemistry information for the Prussian blue product they make.”
Despite all this official encouragement only Heyl Chemisch-pharmazeutische Fabrik GmbH & Co,, a small family-owned drug firm in Berlin, responded. Heyl's tiny factory now produces all the world's drug grade PB, which it markets under the Radiogardase name. The de facto monopoly allows them to sell the drug for $100 for 30 grams even though the raw material is only $3,000/ton.
In October of last year, Heyl's exclusive Japanese distributor Nihon Medi-Physics received Ministry of Health, Labor and Welfare (MHLW) approval to sell Radiogardase, but it has yet to reach the market anywhere.
Trying to source the drug for friends and family in Japan, I asked CEO Alexander Heyl about this dearth in early May, shortly after he visited Tokyo for “official talks.” He said supplies are in fact being made available, but he was not at liberty to divulge how much he is shipping or to whom. He directed me to Kiyoshi Tatsuo, Nihon Medi-Physics' sales manager, but Tatsuo-san swore he had no stock at all for hospitals or the public and that anyone wishing to order it would have to wait at least five or six months.
Since whatever quantities Heyl is shipping seem to be vanishing quietly into government stockpiles, this route was evidently not going to help my friends or answer Japan's urgent needs.
Given PB's decades of medical history, its nonproprietary status and the FDA's urgent efforts to develop new sources of supply, Japan's leading generic firms seemed the next logical possibility. Unfortunately, the research and development executives at Sawai Pharmaceuticals and Towa Yakuhin respectively responded, “Sawai is just not interested in radiation period” and “MHLW has classified Prussian Blue as a 'new drug' so Towa can't create a generic version for at least 8 years.”
The MHLW Pharmaceutical and Medical Safety Bureau later clarified to me that they may consider other PB products during that time, but FDA assurances notwithstanding, all prospective makers would have to submit the same voluminous safety and efficacy studies required for any new prescription drug.
In sum, thanks to bureaucratic dysfunction and/or corporate disregard, Japan is compounding a dire and widening public health emergency because it can't or won't release a harmless antidote that's been around for 50 years. For the nation's already affected citizens and the many yet to come, this artificial embargo is both injurious and insane.
It may take a public outcry or an entrepreneurial epiphany, but with so many lives now in harm's way, this criminal neglect of a spreading carcinogen must be addressed immediately.