This Podcast Will Kill You - Ep 53 Radiation: X-Ray Marks the Spot

Episode Date: July 7, 2020

“I have discovered something interesting, but I do not know whether or not my observations are correct.” With these words, Wilhelm Röntgen introduced the world to an invisible power, a power which would in turn be used to both harm and heal. This week, we take a tour of the wide world of radiation, starting with a primer on what radiation actually is and how it works, courtesy of Dr. Timothy Jorgensen, Associate Professor of Radiation Medicine and Director of the Health Physics and Radiation Protection Graduate Program, Georgetown University. Then we discuss the nitty gritty on what radiation does to you on a cellular level. We follow that up with a stroll through some of the major moments in the history of radiation - from X-rays to atomic bombs and from radioluminescent paint to cancer treatments. Finally we wrap things up by chatting about the many amazing medical applications of radiation therapy and how you can assess the risk/benefit of that X-ray or mammogram.To read Dr. Jorgensen’s incredible book Strange Glow: The Story of Radiation, check out his website or head to our website for our full list of sources. See omnystudio.com/listener for privacy information.

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Terms and conditions apply. Visit blue apron.com slash terms for more information. This is Special Agent Regal, Special Agent Bradley Hall. In 2018, the FBI took down a ring of spies working for China's Ministry of State Security, one of the most mysterious intelligence agencies in the world. The Sixth Bureau podcast is a story of the inner workings of the MSS, and how one man's ambition and mistake. opened its fault of secrets.

Listen to the Sixth Bureau on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. I'm Amanda Knox, and in the new podcast, doubt the case of Lucy Lettby, we unpack the story of an unimaginable tragedy that gripped the UK in 2023. But what if we didn't get the whole story? Evidence has been made to fit.

The moment you look at the whole picture, the case collapsed. What if the truth was disguised by a story we chose to believe? Oh my God, I think she might be innocent. Listen to Doubt, the case of Lucy Lettby, on the Iheart Radio app, Apple Podcasts, or wherever you get your podcasts. Just a warning out there, this is a pretty gruesome firsthand account, and so if you would choose not to listen to it, please fast forward a few minutes. The midsummer sun was already glaring on the morning of August 6, 1945. After the all-clear signal following the air raid warning, everything went back to normal, with people busy doing their own business.

Going on an errand to a post office in Mayuki Bashi under the scorching sun, I could not bear the heat anymore, so I turned back home to fetch my parasol. I was just about to open the parasol at the threshold when an intense flash burst upon me. The flash was a yellowish-orange color, just like the magnesium light, but hundreds of times stronger. I instinctively rushed back into the house and laid myself down on my stomach as had been trained in evacuation drills. Stepping outside, I found the clear blue sky had turned dim as if it were at dusk. Dust in the air blocked the view across the river. The place was filled with an indescribable smell. Pulling myself together, I looked back at my house to see if my mother was all right. Her hair was a mess and standing on end. Her lips were cracked and her head bleeding.

She stood there like some unearthly creature. Then I saw my younger brother staggering about with his white cotton kimono soaked with blood. Are you both all right? I asked. That's my blood. He's not hurt, replied my mother. We carried her on a stretcher to the mutual aid hospital, where the doctor sewed up the cuts in her lips, jaws, and shoulders. But he did not do anything for her wounded wrist, as it had already been given first aid. Because of this, it took a long time before the wound got better, and the thumb and the index finger of her right hand were left to be paralyzed.

Mother passed away in January 1995. I also remember seeing a woman lying dead at a house by the riverbank. Her neck stuck through with a piece of glass blown by the blast. The glass must have cut the artery. Blood was scattered around her. She had been suckling her baby. The baby was still absorbed in sucking the breast. There was a middle school student who was severely burned above the neck,

except for the top of his head, which had been protected by his combat cap. He was walking barefoot saying, Please give me water. I'm hot. Hot. His school uniform was burned to tatters. There came a drove of people whose faces and clothes were burned black, almost naked and burned beyond recognition.

They came tottering along, dangling their arms in front of them like ghosts. Some had their work pants burned away, save the elastic strings. Others had all their clothes burned, except for the front part. They kept chanting, water, give me water.

Exposed, juicely wet. flesh, peeled skin hanging from their fingertips like seaweed. An unfamiliar smell was floating in the air around the mutual aid hospital. Dead bodies were piled up on the roadside. Strangely enough, I never felt the dignity of life as seriously as I do now, faced with so many deaths. Had my mind stopped working after experiencing such a sudden attack by the bomb? I took my father back home from Nino-Sima on August 8th. Flies swarmed around him because of the odor, his festered burns, the white ointment gave out. It took some effort to chase the pests away. On the way to the mutual aid hospital, there was a first aid station where wounded people in a serious condition

were laid on straw mats. They were delirious, begging for water. Those whose backs were burned lay on their stomachs, and those whose front was burned lay on their back. They could not even move to change the position. Their wounds and burns were covered with countless flies laying eggs there. Those eggs hatched into maggots, and these crawled all over their bodies, causing them infernal agony. My father asked for water. Knowing he would die if he drank too much, I only gave him a tiny cup of water. I did so because I wanted him to survive. I am not sure if I did the right thing, and my heart aches whenever I think of it. On the day of Japan's surrender, he mumbled, Japan lost the war. He died undramatically the next day, complaining of the cold.

The damage caused by the bomb was not confined to those who were actually exposed to it. People who sustained no injuries, e.g. those who went near the hypocenter to look for their children, suffered a high fever, and got purple spots all over their bodies, went almost mad, and died one after another during the six months following the bombing. My elder brother was suddenly stricken with leukemia and died many years after that dreadful experience when we had almost forgotten about it. I myself suffered from diarrhea for some time at the end of August. It is not easy for me to talk about my experience as an A-bomb survivor.

For me, it is like airing my dirty linen in public. But here I am to talk to you, because I really want all of you to remember that the peace we have today has been achieved through the sacrifice of those people who were mercilessly killed without receiving a drop of water to quench their thirst. To keep a lasting permanent peace, I want to convey the heart of Hiroshima, hoping that what I do will be like small ripples growing into big waves and into a tidal wave. Oh my God. Yeah.

It's, I have no words. No. So that is, that is the story of Miyoko Watanabe, one of the Hibakusha, which is the survivors of the A-bomb. And there are so many of these that have been collected in a big project. really encourage people to go seek out more of them because it is just, yeah. Yeah, no, my goodness. Yeah. Wow. Yeah. Hi, I'm Erin Welsh. And I'm Aaron Alman Updike. And this is, this podcast will kill you. And today we're talking about radiation. Yeah, it's a very, very big topic. Massive topic, absolutely. I don't know how this episode's

going to turn out, Eric. Me neither. I don't know if we're going to do it justice, but we'll try. We'll try. We'll do our best. That's all we can do. Yeah. Well, we are very excited this week because, you know, radiation is a very interesting topic.

It's got a massive history. The biology is super fascinating. And we were fortunate enough to speak with Dr. Timothy Jorgensen, who is Associate Professor of Radiation Medicine and Director of the Health Physics and Radiation Protection Graduate Program at Georgetown University in D.C. And he wrote the incredible book called Strange Glow, which... It's really great. It's really, really... It's like one of the best examples of science writing I have ever found. I love it. I agree. It explains, I am, I never took the time to learn physics properly back in undergrad. And so, like, this was a very

intimidating topic for me. And I feel like in our interviews, he explains it so beautifully and his book is just so clear and it's it's engaging to read it's really really great highly recommend it's yeah totally it's really it's really great and so we are going to bring him on to talk first about the physics of radiation and radioactivity how it works what the different kinds are and and then we're going to dive into the biology right and then the history so pretty much standard but we've got bring in some outside expertise who can talk about physics much better than you or I could do. I would never be able to do it.

No. Although I will admit that like after this, after reading his book, I was like, oh my gosh, I wish I had taken more physics. I wish I had like studied more about this because it is so beautiful some of the like examples of the logic that you need to like understand, oh, you know, how was Bragg's peak measured? Whatever. Okay. We're getting too much into the weeds already.

But still. Absolutely. Oh, yeah. Well. Well, first of all, important business before we get started, it's quarantine time. It is quarantini time. What are we drinking this week? We're drinking glow and behold. Great name. Great name. Shout out to Andy. Thank you so much. So what's in glow and behold, Aaron? Fantastic question, Aaron. Glow and behold has gin, lemon. juice, Midori, which gives it that lovely neon green color, and egg white. So it's like a gin fizz kind of a thing. Fantastic. We'll post the full recipe for that quarantini as well as our non-alcoholic placebo-rida on all of our social media channels and our website. Do we have any

other business? I don't think so. I think we should just dive in. All right. Let's start off by learning some physics of how radiation works right after this break. Dinner shows up every night, whether you're prepared for it or not. And with Blue Apron, you won't need to panic order takeout again. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients so there's no meal planning and no extra grocery trip. There, assemble and bake meals take about five minutes of hands-on prep. Just spread the pre-chopped ingredients on a sheet pan, put it in the oven, and that's it.

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Terms and conditions apply. Visit blue apron.com slash. Terms for more information. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keeffe's Working Hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry,

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Hall. This MSS officer has no idea the U.S. government is on to him. But the FBI has his chats, texts, emails, even his personal diary. Hear how they got it on the Sixth Bureau podcast. I now have several terabytes of an MSS officer, no doubt, no question, of his life. And that's the unicorn. No one had ever seen anything like that. It was unbelievable. This is a story of the inner workings of the MSS and how one man's ambition and mistakes

opened its fault of secrets. Listen to the Sixth Bureau on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. My name is Tim Jorgensen, and I'm a professor of radiation medicine and biochemistry at Georgetown University School of Medicine. I've been working there for a number of years. And I have a PhD in radiation health sciences from the Johns Hopkins School of Public Health. And my background is I'm really trained as a radiation. biologist, which has led me into various aspects of that. And I run a graduate program in health physics at Georgetown. Excellent. So could you start us off really broadly just by explaining

what is radiation and how does it work? Okay. So the simplest way to think about it is it's energy on the move, basically. It's energy moving through space, and that can be empty space or that can be solid space. It's because depending on the type of radiation, it has the ability to penetrate things like x-rays. It's really, there's two fundamental types. There's the electromagnetic type. It moves as waves, and we're familiar with that, microwaves, radio waves, x-rays,

gamma rays, and things like that. But then there's another less well-known type called particulate radiation that is actually little pieces of atoms. And we also have heard of those terms, too, like alpha-brate. particles, beta particles, things like that. Those are the particulate types of radiation. So it comes in two flavors, electromagnetic and particulate. But the ones that we're most concerned about are those that are called the ionizing

radiations. So they have enough energy that they can actually damage chemicals. They can break covalent bonds. And that's what we think the mechanism for all the health effects are. So we focus a lot on the ionizing radiations because those are the ones that pack the punch in terms of health effects. Gotcha. So you mentioned at the beginning that there are these different types of radiation, electromagnetic particle. Could you go into a little bit more detail on what those different types are and sort of the differences between them? Sure. So let's start out with the

electromagnetic radiation. So these are all essentially the same thing. They're waves of electromagnetism that are going through space. And they're all the same. The only thing that's different is their wavelength. So usually people talk about light first, because that's right in the middle. Waves of lengths of light are around just a few hundred nanometers. And the thing that's interesting about this, this is the only part of the entire spectrum that humans can see. When things get longer than light, then we start getting wavelengths or longer. These are weaker types of radiation. And think radio, Think microwaves and things like that. These are traditionally called the non-ionizing radiations.

So some of these are very long. Like radio waves are about the length of a football field. And x-rays on the opposite side, they're just like a hundredth of the width of the human hair. So that's the range that we're talking about. So as we go to the shorter wave lengths, the energy keeps going up and up and up. First, we hit the x-rays, and then beyond them are the gamma rays. Gamma rays are much shorter, so they have the highest energies. And everything with these shorter wavelengths, shorter than visible light,

these are called the ionizing radiations because they have enough energy to actually rip electrons off of atoms and produce ions. That's what we call them ionizing radiation. And the reason that that's not good is because they break chemical bonds, particularly in biological molecules. So they're capable, for example, of ripping electrons off of DNA and causing breaks in DNA and other chemical reactions to happen. And so this is the mechanism of what we think all the biological consequences are.

So we worry about the ionizing radiation. We don't worry so much about the non-ionizing radiation. And then there are the particulate radiation. So the particulate radiations are released from radioactive materials. So radioactive materials are all atoms are. a combination of protons and neutrons in their nucleus. The stable ones, the ones that are non-radioactive, tend to have an equal number of protons and neutrons in their nucleus.

But that doesn't have to be the case. And whenever there's excess protons or excess neutrons, the atom is unstable. And what it does is it does something we call decay, and that means that either a proton becomes a neutron or a neutron becomes proton. And when that happens, energy is released. Now, the energy can be released in the form of gamma rays, which are the electromagnetic radiation, and or it can also release particles. And so those particles, the most common ones are something called the beta particle,

which is a negative particle, equal in size and mass to an electron, except that it comes out of the nucleus. That's a beta particle. larger particles are alpha particles, and alpha particle is really like a helium nucleus without the electrons on it. Alpha particles on beta particles are the classic examples. There are other examples of things that are emitted, fission products and things like that, but those are the main ones. And these particles also, because they're charged, and they have high energy, they move through materials and ionize things along the way. And so that's why we call them ionizing radiations

as well. And we believe, for the most part, they act on materials, biological materials, in the same way. They rip electrons off, cause damage to chemicals, particularly biological chemicals, and that's the mechanism of their action. Gotcha. Can you talk a bit about why there's no safe level, quote unquote, for radiation exposure because of the cellular damage? Okay. So the key in terms of safety is that everything is, related to dose. And so what we mean by dose is the amount of energy that's deposited in the material. And so the more energy you deposit in something, the more likely you are to damage it. So you can have relatively high doses. At very high doses, the damage is so severe that it will

actually kill a cell. And the way that it kills a cell is by damaging the DNA. So the DNA is the critical target. And the reason we keep saying DNA, DNA, DNA, every Everything else in the cell can be replaced. All the proteins can be replaced, all the RNAs, carbohydrates. Everything can be fixed and replaced. But there's only one set of DNA and each genome has two copies. If you cause a lot of damage to the DNA, the DNA can repair some of that damage, but it can't repair a lot of damage.

And so the cell will die. So these are consequences when the doses are relatively high, and that's what causes radiation syndromes, radiation sickness and things like that. But when you get to doses below which you cannot kill cells, then essentially you don't have any of those effects. And what you really have now is an increased risk of mutagenesis. Now, most of the time, this scrambling or mutation is of little consequence. So let's, for example,

Suppose you have a liver cell and the radiation damages the hemoglobin gene in the liver cell. Well, liver cells don't produce hemoglobin. They don't really care that their hemoglobin is damaged. They just keep going on. But if you should get a mutation in the gene that regulates growth, then you can have a problem because growth regulation is what's keeping us from having a cancer. So if the cell loses its ability, control, its growth, it starts to proliferate, and then you have a cancer. So we say that there is risk involved at every dose.

That's rather controversial. And the reason it's controversial is there are some scientists that believe that that's not true. And the reason they don't think it's true is because we know that cells can repair low levels of damage. But these levels are so low that we cannot measure the amount of damage and repair the damage. those levels. So that may be true. It could very well be true, but conservative assumptions are that some damage happens at every level because we cannot rule it out. Gotcha. So kind of switching gears a little bit and talking about radiation, not as much of something that will give you cancer, but something that is used to treat cancer. We've come a long way in terms of the

specificity and how accurately you can target certain tumors and so on. But, But can you talk a little bit about how that works maybe and some of the risks associated? Yeah. So the actual, the initial thought with radiation therapy is that it would be an ideal agent for treating cancer because it exploits that sensitivity of rapidly dividing cells. So when you have a tumor embedded within a normal tissue, the tumor is dividing more rapidly than the normal tissue is. So if you hit it with radiation, it's the tumor that will be preferentially killed by the radiation. And that is the underlying basis for radiation therapy. So it's also given infractionated doses because, so if you've known anyone who's had radiation therapy,

usually they come back every day for a period of time and they spread the dose over several weeks. And the reason for that is that the normal cells, repair better than the tumor cells. So by giving a rest between doses, the normal cells can exploit that rest and repair themselves better than the tumor cells can. So you have another differential. So you have two differentials. You have the happily dividing cells and the better ability of the normal tissue to repair itself

compared to the tumor. And for that reason, it's a very effective treatment for cancers. I think a lot of people also don't necessarily realize that, you know, we're exposed to a certain level of background radiation all the time just by living. Can you talk a little bit about what that is and where it comes from? Yes. So we received background radiation from a number of sources, both internal and external to our bodies. A lot of natural chemicals that we have in our body have atoms that are radioactive. And some of the most famous ones that we hear are about potassium.

And potassium is a major part of the electrode lights in our body. And potassium 40, a component of that potassium is radioactive. There's a lot of potassium in bananas. So if you eat a banana and you have excess potassium, you pee out the same amount of potassium that you just ate. So there's the radioactivity that's in your body. I believe that your internal normal radioactivity contributes just a couple of percentage points to your total annual background does. But then there are external sources of exposure, and a lot of that comes from the ground.

For example, there's uranium and radium in the ground. That varies tremendously about where you are in the country, but you get some of that. So people who live in brick buildings or mortar buildings, they get some radiation, more radiation exposure, people who live in wooden buildings. We get a lot from cosmic radiation. So cosmic radiation is radiation that's coming from the sun and out other areas of the solar system and pinging on earth. And then we have exposure from radon. Radon is a major source of exposure for those people who have radon in their homes largely. But it acts more like a spring. So you know how a spring will pop up here and not be there? So you could put one house on top of a radon spring. And the

next, the neighbor have nothing. But anyway, radon is a concern because you can breathe it and it can reduce, it can irradiate your lung and it can reduce lung cancer. It doesn't do anything else other than produce lung cancer. Those are the major sources, but then apart from those things, we also have to consider the average number of diagnostic and therapeutic radiation procedures that people have. And so now that's amounting to, I think about a third of the total background dose that people are getting annually. But again, that's spotty because one person may have a lot of procedures, and then the other person may have none.

So anyway, but on average, for people living at sea level, they get about three milliseconds of background radiation a year. But, again, it varies. So, for example, people that live in Denver, they get about 12 milliseconds. And the reason that they're getting it is because Denver is the mile high city, right? So the air is thinner up there. They end up getting more exposure to cosmic rays. And so they have a higher background level.

So within the United States, the range is generally between three and 12 milliseconds per year. But it's very heterogeneous among the population. But that's the general range. Awesome. So you kind of touched briefly earlier about this. But I was wondering if you could explain a little bit more about the differences in elements and what makes some elements radioactive and others not? Okay, so let's go back to the supernova that created our solar system.

So you can think of this as a huge explosion like the Big Bang, and all the elemental subatomic particles, the protons and the neutrons, they all just scrambled and coalesced and came back together. The ones that came back together with five, protons and 14 neutrons, they were so unstable, they disappeared instantly. And so the further away from being one-to-one ratio of protons to neutrons, every combination was possible. But the ones that were too far out of the mainstream instantly disappeared. And so what we're left with after time are those things that are pretty close to one-to-one. And they're still in the process of becoming

one-to-one. They're still in the process decaying. So if, If you draw a line, they call the diagonal of stability. You put the number of protons, you put the number of neutrons on a chart, and you wrote all the stable ones. They would fall along this line of stability. And then if you had things with other combinations, the further away from that line, the shorter their half-life rate. So everything we're left with now is clustered around the line, because these are things that

have half-lives anywhere from, you know, hundreds of years or so to thousands of. thousands of years, you know, so they're long enough to persist in our environment, okay, but they're still on their way to this everything becoming stable. That is so cool. I just, it's fascinating. So then talking about some of the times where we see these unstable elements is when we talk about nuclear bombs or we talk about a meltdown at nuclear power plants. Can you talk a little bit about, first of all, just a little brief overview about maybe what criticality is or what the self-sustaining reactions are and how that works in nuclear energy and then also a bit about what happens in nuclear bombs in that same sort of in a

parallel way. So basically we're talking about now fission. So I didn't really talk about fission when I talked about radioactivity, but there is another way that very, very large things becomes stable, more stable quickly. Okay. And that is they just split. So uranium is up there, the common uranium elements are like 235 to 238. These are huge atoms. Some of those atoms will just spontaneously break apart. That's what fission is. When that happens, you will have fission particles. You have two smaller pieces, but also you'll have neutrons that will just break off and fly out. So the thing about these neutrons are that if they hit, a neighboring uranium atom, they can induce them to split.

And the specific isotope we're talking about is uranium 235. And when it splits, it releases about two or to three neutrons, I believe, for every fission. So you can imagine that if this one were to split and release two, let's just say two, and it would hit two other atoms and they produce two, and then two other atoms, and they produce two, you can see you have a chain reaction. And so you have all the uranium atoms disintegrating. That's what nuclear chain reaction is. So why doesn't that happen?

The reason that doesn't happen is because neutrons are very penetrating. And so if you have a mass of uranium like this, most of them will escape that mass before they interact with another uranium. But if you keep increasing the size of the mass of uranium, you get to a point where most of them are not escaping anymore. They're staying within that mass. And that is a critical mass. And what makes it critical is you have enough mass there now that you will have a chain reaction.

You have a self-sustained chain reaction because the neutrons cannot escape. So in terms of how that's used in nuclear power, if you can control that, and you can control that by determining they usually put the uranium in rods and they move them in and out of a contraption that determines how many neutrons are going to escape and how many are going to stay in. They can control that reaction. Those reactions produce heat. And after that, it works just like any other power plant. It produces heat. Heat turns a turbine. Turbines make steam, you know, and electricity, and that's how it works. It's just a means to produce heat. And as long as you can control that, you have a nuclear power plant.

In a nuclear bomb, it's the same principle, but you produce criticality instantly. You push all the uranium together at the same moment, and you produce this instantaneous criticality, which results in a huge explosion. And that's the basis of a nuclear weapon. That was awesome. Thank you so very much, Dr. Jorgensen. It was so great to talk with you. and thanks again for writing such an incredible book.

Yeah, we really appreciate the time that you took to explain everything so clearly and how awesome that book is. Really great. Yes. Well, then, now that we understand some of the physics of how radiation works, let's talk about the symptoms that we see, shall we? Let's do it. Okay. So, like Dr. Jorgensen so beautifully explained, a lot of the damage that is due to, to radiation has to do with the free radicals that it creates that damage DNA directly.

So we'll talk a little bit more in detail about that. And then we'll talk about the acute and the chronic effects that we see from radiation exposure. Sound good? Sounds great. All right. I mean, sounds terrible, but yeah. Yeah, I know. That's true of all of our episodes, though, so nothing new.

Yeah. All right. So acutely, right, like shortly after exposure to, to radiation, like Dr. Jorgensen explained, you're making these free radicals that are damaging your DNA. So we can guess then, and we are correct, that the cells that are going to be the most affected by that type of damage are cells that divide rapidly or divide often. So we can exploit this when we think of tumor cells, which are rapidly dividing cells, and that's why we can use radiation as a treatment for cancers.

But it's also going to affect things like our epithelial cells, which are the linings of our gut and our lungs, our skin cells, the hair follicles, our cells that replicate rapidly, our blood cells. All right. So it explains leukemia. It explains the GI symptoms. Exactly. And it also, I think I remember reading this, but like,

Cells, you know, if you think about the opposite end of the spectrum of, like, tumor cells, you think of nerves. Yeah. That's why we don't see a lot of that. We'll talk about that in detail. But yes, you are 100% correct. In general, nerves and your brain cells are actually quite resistant to the effects of radiation. And it's largely because they replicate so infrequently. If at all.

So interesting. It just makes, like, it's just like, oh, my gosh, it makes sense. It makes sense. That was such a big. I feel like there is such a big black box around how radiation works. That makes people like very scared of it or very, but like also rightfully so. Yeah. And I think that, you know, part of assessing where our fear level should really be is just breaking down that black box. Absolutely. Understanding like how it actually works. I agree entirely. Yeah. But another thing I do want to say that another mechanism of damage beyond just this.

DNA damage is that these free radicals that are produced by radiation, so radiation isn't the only thing in the world that causes free radicals to be produced. And actually, bacterial infections often result in the formation of free radicals. So our body knows how to respond to the production of free radicals and can actually go ahead and like minimize the damage. The way that it does that is through the inflammatory pathway. So exposure to radiation also results in our pro-inflammatory pathways being activated. So that means that kind of long-term and chronic exposure to radiation can result in a lot of like long-term inflammatory symptoms. Okay. Does that make sense? Yes. And long-term inflammatory symptoms, isn't that, like, also increase your risk for cancer an absolute time?

Absolutely, absolutely, absolutely. Yeah. Okay. Okay. So now that we have that, even more context, let's talk about some of the different symptoms that we see, depending on the amount of radiation that you're exposed to. Okay. All right.

So first, we'll get the worst of it out of the way. And you heard about this in our first-hand account. And that is acute radiation sickness or acute radiation syndrome. So this is what we saw from people who worked at Chernobyl. This is what we saw after the atomic bombs in Hiroshima and Nagasaki. And it's also been described in some cases after total body irradiation for treatment of cancers. But that's not normal and pretty rare. Okay.

Well. So. Yeah. Oh, I guess you'll probably tell me whether it's actually rare. In modern day. Yeah. All right. So there are a couple of different, three different clinical syndromes that can happen after acute radiation exposure.

And the type that you will get will depend on the amount of radiation you were exposed to. So those three are neurovascular, which means central nervous system and vascular. So blood supply effects. Hematopoetic, which means your stem. stem cells that produce blood cells, white blood cells and red blood cells and platelets, and gastrointestinal. Those are the three syndromes. So let's go through them. The Neurovascular syndrome requires the highest doses of radiation to see that syndrome. In general, it's over 20,000 milliseconds of exposure, which is a huge, huge amount.

of radiation. Okay. If you're exposed to that much radiation, that's how much it takes for your brain and blood vessels to actually become affected. So the symptoms that you see are things like headache, which is very severe headache, apathy, lethargy, seizures. Because it affects the blood vessels, your heart will start to go into an arrhythmia, and basically you're dead within 24 to 48 hours. Just to your body just shuts down. Absolutely. Your brain and all of your blood vessels just are wiped out. The cells are just destroyed and so you die.

Not great. Okay. Next syndrome. The gastrointestinal syndrome. This generally happens after exposure to also very, very high amounts of radiation between 10 and 20,000 milliseconds. Okay. And your GI tract, we already talked about, is very, susceptible to the effects of radiation. So these symptoms are going to be like nausea, vomiting,

diarrhea, anorexia, so not wanting to eat anything, huge amounts of abdominal pain. You can get distension. It can affect the cells of your gastrointestinal tract so much that they are unable to undergo peristal cysts, so they stop moving. So you're not basically able to move any food or liquid through. So you're not absorbing things properly. You can become mass massively dehydrated and you'll likely die. But it's a slower, more prolonged death than with the neurovascular syndrome. Wow. The hematopoetic syndrome is what happens when your bone marrow, your blood cell regeneration stem cells are affected. So the first cells that tend to be affected are your lymphocytes, which are one group of your white blood cells, and then your

granulocytes, which are like your neutrophils, another white blood cell, then your platelets, than your red blood cells. So basically, whichever cells turn over the quickest are the first ones to start to die off and not be able to be replaced. Those purple spots that you described in the first-hand account, those are because of hemorrhages

because your platelet count is low. So that's not good. And so basically, because your blood cells, especially your white blood cells, as those start to decrease, your body is defenseless against other pathogens. So if you don't die from that and then from bleeding because you don't have any platelets to clot your blood, then you die from super infections.

So bacterial infections or viral infections or reactivation of any latent infection. So it's really common if you have like an underlying, a lot of us have viruses just sort of hanging out in our bodies that never cause problems until you have no white blood cells to fight them off. Right. So you generally see the hematopoetic stem cell effects anywhere from about 1,000 milliseconds all the way up to 10,000 milliseconds of exposure to radiation. But you usually won't die from it unless it's at least more than 5,000 milliseconds milliseconds of exposure.

So one of the things that I thought was interesting is that in one of the books that I was reading, it talked about how, you know, know, in some of these tests, when they tested like the hydrogen bomb or something, there would be soldiers at different distances from that. Yeah. And within that same distance, which first of all, you could then see like the stages of the very dose dependent, but even within a certain, quote, unquote, dose, you had differences in reaction. Why is that? That's a good question. I don't, I don't fully know the answer, whether it has to do with like how much your body just happens to be able to be resistant to it.

Like if you're really young and healthy and you don't have any latent infections, then maybe you can survive that hematopoetic effect. Whereas someone else who, like, has CMV, you know, that gets reactivated so they end up deteriorating faster. Or whether it just has to do with, like, maybe even though you were standing at the same distance, you were at a different angle so you got exposed differently. You were wearing different clothes. so your exposure was different.

It's a really good question. Yeah. But so that's kind of the acute radiation syndrome. And again, this, if you are exposed to less than about 500 milliseconds of total body radiation, you basically won't see any of these syndromes. Of the acute. Of the acute, exactly. And there are also phases of this illness, especially.

as you're exposed to the lower, lower, but still higher than 500 dosages, where first onset, you'll have like a prodromal phase where you'll still get nausea and vomiting even minutes or hours after exposure, or it might be kind of days or weeks after exposure. And then there'll be a period of time where you're kind of asymptomatic, where like your GI symptoms have cleared up. And then you'll go on to have more of the stuff. cell of your blood cell effects where your cell counts will drop, etc. So you go through all of these phases and how long each of those phases last and how long it takes between them depends on the total, total body exposure to that radiation. What symptoms you're going to see depend on what cell

type and how long the turnover is, how quickly those cells replicate. So the GI symptoms are some of the first that you see because the turnover of our epithelial cells of the GI tract are like seven or eight days. Like, it's really fast. Whereas our red blood cells have a lifetime of about 120 days. So it takes a long time before you'll see any anemia from radiation exposure. Uh-huh. Yeah. Okay. But then white blood cells have a shorter half-life. Platelets are somewhere in between. So, yeah. So it's really gnarly. But again, that's all acute radiation syndrome, which is from exposure to very, very high levels of radiation, which is very, very rare in the modern day and age.

It's not impossible, but it's very rare. Right. So what about chronic effects? What about the normal kind of radiation that we're all exposed to? What is that? How does that affect us? Okay. Basically, the biggest risk overall of late radiation exposure,

So kind of cumulative radiation exposure over your lifetime, whether small amounts overtime or a large amount all at once, but not enough to cause ARS. The biggest risk is the development of cancer. Okay. Question. Yeah? Is there any treatment? Oh, good question. So for acute radiation syndrome, no, absolutely not.

If you have, for example, like the hematopoetic, so if you don't die for, from the CNS effects, the central nervous system effects, or the GI syndrome. If you have high amounts of exposure and you have this hematopoetic response, the best treatment is essentially supportive care, making sure they're super sterile so they don't get a secondary infection so that their stem cells have time to regenerate and heal, essentially. They have used blood transfusions and bone marrow transplants to try and give some. back those stem cells. But again, because it's generally so rare and there's been so few cases of it throughout the world comparatively, there isn't like a treat, there's not like an antidote

to radiation exposure. And then even chronically, like from, you know, overall exposure, when we use radiation for cancer treatment, there's no treatment for those effects. There's symptomatic relief. So for radiation-induced nausea, for example, which is really common, we have drugs that help to treat the nausea associated with it. They don't do anything to change the effects that radiation is having on the GI tract, but they help your brain deal with the nausea so that you don't feel nauseous. Okay. But in any case, like, you cannot reverse the effects of radiation on yourselves. Nope. Hmm. Hmm. Whomp. Womp. Is that too depressing? I mean, we're not even in the history yet, Erin.

No, I know, yeah. So tell me about that, Aaron. I want to know how depressing it can get. And where this all came from? Like, how did we first figure out radiation? Oh, I can't wait to tell you. We'll take a quick break first. Anyone who works long hours knows the routine.

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believe. The nurse who should have been in charge of caring for tiny babies is now the most prolific child killer in modern British history. Everyone thought they knew how it ended. A verdict, a villain, a nurse named Lucy Letby. Lucy Letby has been found guilty. But what if we didn't get the whole story? The moment you look at the whole picture, the case collapses. I'm Amanda Knox, and in the new podcast, doubt the case of Lucy Lettby, we follow the evidence in here. hear from the people that lived it, to ask what really happened when the world decided who Lucy Lettby was. No voicing of any skepticism or doubt. It'll cause so much harm at every single level of the British establishment of this is wrong. Listen to Doubt, the case of Lucy Letby on the

iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. China's Ministry of State Security is one of the most mysterious and powerful spy agencies in the world. But in 2017, the FBI got inside. This is Special Agent Regal, Special Agent Bradley Hall. This MSS officer has no idea the U.S. government is on to him. But the FBI has his chats, texts, emails, even his personal diary. Hear how they got it on the Sixth Bureau podcast. I now have several terabytes of an MSS officer, no doubt, no question, of his life.

And that's the unicorn. No one had ever seen anything like that. It was unbelievable. This is a story of the inner workings of the MSS and how one man's ambition and mistakes opened its fault of secrets. Listen to the Sixth Bureau on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Okay, this is a massive history, as you might expect, with tons and tons of different aspects to cover. and I'm going to do the best that I can to tell this story, but it's not going to be super in-depth because then we'd have literally like a 10-hour episode. We could do a miniseries on this.

Of course. But each part of the story of radiation has its own history, and I'll recommend a ton of books and some documentaries to watch to get more in-depth info on each of these topics. Excellent. And I have to say, just across the board, every single book that I read, read for this was absolutely incredible, like really fascinating and interesting and well-written and horrifying and all the things. Everything you want in a book.

Basically. All right. So here's what I'm going to do. I'm going to start with the early discovery of radiation from a physics perspective. Awesome. And then I'm going to talk about how the harmful effects of radiation were first discovered, particularly from an occupational exposure standpoint. Yes.

And then a little bit about human experimentation because of course. And then I'm going to talk about how radiation has been used as medical therapy. Cool. I'm not going to go into too much of the story of meltdowns like Three Mile Island or Chernobyl or Fukushima, simply because each one of those is an entire story and I wouldn't be able to do it justice. but I'll recommend some reading, so. Perfect. There you go.

Okay, let's dive in. I have discovered something interesting, but I do not know whether or not my observations are correct. If that is not written in every student's lab notebook. And then, but most of the time, 99% of the time, it's like, nope, just miscounted. Nope, my model had a weird variable in it. But those are the words that Wilhelm Conrad Ronkin said to a colleague of his in December 1895, just a few days after discovering invisible rays that could pass through solid objects. And, I mean, it's maybe not that surprising that he was so skeptical of his own observations

because invisible rays that don't follow the rules of physics. It seems like magic. Yeah, sci-fi novel type stuff. Rodkin, who was an experimental research, empirical evidence kind of guy, he wasn't like a super big thinking theoretician. He had been conducting some experiments in his lab on running an electric current through a crooks tube looking at cathode rays. And he had observed a faint glow that appeared on fluorescent screens that weren't near the tube where he was doing his experiments. Okay. This glow even appeared if he blocked the tube with books or card-due.

board, anything he could find in his lab. So he was like, okay, this has to be a new kind of ray, was one that couldn't be bent by a prism, it couldn't be deflected by a magnet, but it could pass through solid objects. So he gave these rays a temporary name, X-ray, because X, he wasn't really sure what X stood for yet. Yeah, it's like disease X when we don't know. But then it stuck, yeah. And he continued to toy around with these rays and discovered that while they could pass through wood, they couldn't pass through metal.

So then he got to wondering, what about human flesh? Of course. Isn't that the next thing you would wonder? I mean, honestly, kind of. And so when he held his hand in front of the screen, he could see his bones, but not his flesh. Can you imagine? I would love to imagine. Is there a show about this yet? Because I want to watch that episode. Good question. I don't know. Okay. We'll find out. Someone tell us. Like, I mean, to see your bones when no one has ever seen their bones unless they take off the skin and muscle to take a look at it.

Like to see your bones without cutting your skin. What? Yep. Yep. Oh, yeah. It's magic. Well, and it gets even better. Because, like, he was never described as a big theoretical thinker, but he connected these dots pretty quickly between this new technology and its possible application in medicine. Like, he was like, oh, this could be used from medicine. We could use, we could look for things inside the body. Like, okay. I mean, it makes sense, but like, holy cow. And he also realized that if he replaced the fluorescent screen in his lab with photographic film, he could capture the images.

Side note, I still think that photographic film is also like magic. Oh, totally. I mean, so are records and CDs. Yeah, and computers. All of it. Actual magic. Like records especially. I remember laying next to my record player being like, I don't understand.

I've since watched YouTube videos about how it works. I still don't get it. Okay, but you have probably seen one of the very first x-rays ever taken. It's of his wife's hand with her wedding ring. on it. It's very cool. And apparently, after he showed her the image, she was like, I've seen my own death. That's what she said. But I mean, it is sort of like, this is eventually what you return to. It's very interesting. Anyway. So I feel like in so many of the histories that I've researched, it's like someone discovers something amazing and then people ignore it for decades or they don't believe

them or whatever. Yeah. This is not the case with radiation and x-rays at all, at all. Awesome. Awesome. So in almost record time, Ronkin got his finding published in a scientific journal, and less than two weeks later, there were newspapers all over the world announcing this discovery, this new kind of ray that allowed you to peek at your skeleton. Oh my gosh. Researchers were able to easily replicate Ronkin's experiments because the equipment was pretty simple, and some kicked it up a notch, like immediately applying it to medical intervention. So the first time that it was used in a medical intervention way was to help surgeons locate a bullet in a guy's leg, which they were able to successfully remove. And we still do that. How cool.

We still do that. Okay. So December 28, 1895, X-rays are first published in a scientific journal. Okay. February 4th, 1896. So like less than two months later, They are used to help save a person. Has anything ever moved from discovery to applications so quickly? Certainly nothing we've ever talked about. No. And, you know, like, it's sort of a mixed blessing because we had this amazing power, you know, ethics and knowledge moves at a much slower pace than technology. So, anyway, for his work, Ronkin was awarded the Nobel Prize in physics.

in 1901. And side note, in the first half of the 20th century, there were over 21 Nobel prizes in physics for research related to radiation and won in physiology or medicine. Wow. That's a lot of Nobel prizes. Yeah, it is. As you can imagine, the history of radiation is filled with many, many sad stories. And some of those are about people not knowing the dangers of radiation and, dying horrible early deaths.

Rontgen actually always protected himself. I don't know whether it was out of just like an extreme caution. But he died in old age, apparently not ever having been negatively impacted by the rays that he discovered. But not so lucky were Edison, who through his work on a florescope, nearly lost his eyesight. And Edison's assistant, Clarence Daly, fared even worse. So he first got severe burns that covered his hands leading to amputated fingers and then a hand and then cancer creeping up his arms into his chest, which is what ultimately killed him.

Okay, so as we have talked about, radiation is a broad word for, you know, this whole episode because there's ionizing and non-ionizing radiation. There's particulate and there are differences in which of these types of radiations can hurt you and how they can hurt you. Right. And the doses and blah, blah, blah, blah, blah. Yeah. So I've talked about one type of radiation

and how it was discovered, x-rays. Right. But I want to talk about how particulate radiation was discovered. Yes. And it actually wasn't long after Ronkin's discovery of x-rays when a guy named Antoine Beccarell started wondering about the link between x-rays and fluorescence. In particular, where was that visible glow from the fluorescence coming from?

Yeah. Beccarell, isn't that a unit or something? Uh-huh, yeah. Yeah, okay. Basically, if you were one of the first people who worked on radiation, you had a unit named after you. Curie is next. Ronkin, Beccarell, Curie. Great.

So in 1896, Becaryl tested a bunch of chemicals, and, long story short, found that the presence of uranium sulfate alone would expose film without the help of other light source or x-rays. So he concluded that uranium atoms emitted some kind of invisible radiation along the same lines as x-rays. In short, he discovered radioactivity. Yes. So Beccarell, along with Marie Curie and Pierre Curie, aka the French trifecta is what they were called. They were awarded the Nobel Prize in physics in 1903. So again, just rapid-pay stuff going on. Yeah, 1903, that's only a few years.

later. Oh, yeah. Yeah. And uranium, of course, would go on to play a major role in the history of the world, as I'll talk about later with the development and deployment of atomic bombs, as well as with human experimentation. Oh, naturally. So Becquerel got out of the radioactivity game pretty early, but the Curies would go on to contribute to the field for years and years. They were the ones who actually coined the term radioactive, which is pretty cool. cool. For their share of the Nobel Prize, the curies realized that uranium ore actually emitted more radioactivity than could be accounted for by just uranium alone. They found that there were at least three radioactive elements in the ore, uranium and two new ones, one which they named

Polonium after Poland, which was where Maria was from, and radium, which is from the Latin word for ray. Side note, Marie also died of radiation poisoning. and her body is in like a lead casket that's protected by like a lead, whatever, because there was so much radiation in it. Oh, my gosh. Research on x-rays and radioactive elements continued at full speed throughout the 1920s and the 1930s, and the start of World War II brought this increased urgency to it, as well as a narrowing focus on the possibility of nuclear weapons. Which is just so typical of humans. I know, I know, man. Hey, here's this, you know, so powerful thing.

How can we weaponize it? Yeah, rinse and repeat. Let's experiment on our most vulnerable populations without their permission and find out. Oh, yes. Let's not jump the gun now, Aaron. There's plenty of that. Plenty of that in here. Okay.

So for a while, it had been. thought to be too impractical. Like there's no way we could actually make these nuclear weapons, but then when the concept of these self-sustaining chain reactions, so criticality, as Dr. Jorgensen talked about, once that was discovered, then it was like, oh, we can do this. So if you can get that criticality to happen, you've harnessed an absolute, unbelievable amount of energy. But if you lose control of it, you're looking at a meltdown, as we've seen happen. Or a bomb. Okay.

In a project headed by Enrico Fermi under the University of Chicago, criticality was achieved on December 2nd, 1942. Wow. It's about the midway point of World War II. Okay. Yeah. And this work would pave the way for the Manhattan Project and the development of nuclear weapons. Wow. And I'm not going to go too much into the history of the Manhattan Project itself.

But by the time that the project was underway, the development was underway, the development. The dangers of working with radiation had been well recognized. And research done by Herman Mueller, so he was a Nobel Prize winner, and also a huge proponent of eugenics. He loved eugenics. Great. What a stand-up guy, not at all. So he showed that radiation induced genetic mutations in fruit flies, and that finding attracted a lot of medical science attention. Gross.

Because if it caused mutations in fruit flies and their DNA, what would it do to humans? How much could hurt you? What was a safe level? Was there a safe level? And as more and more people worked with radiation, its dangers, both short and long term, became more clear. So whereas the dangers of electricity were very much feared in its early days, maybe helped along by the alternating current smear campaign by Edison. more about, I would love to do an episode on Edison and Tesla just because the history is so interesting. I was waiting for you to smear Edison.

Like you mentioned him earlier and then didn't smear him and I was a little shocked. Oh, no, it's happening now. It's not even really relevant to the discussion of radiation, but I just had to throw in that. You had to sprinkling. But did you know? Anyway, so. But electricity, you could directly see the day. damage that it could cause, right? You could electrocute a person, an animal, a tree, whatever.

But the effects of radiation were mostly invisible. Right. And so precautions weren't always taken. And when they were taken, it was often too late. Well, and also, like we talked about, sometimes the effects are so long after exposure, it's even hard to correlate back. Mm-hmm. Mm-hmm. Right. But still, a lot of the people who had been working with radiation were working with these incredibly high doses. And so the negative health effects of radiation had been known basically ever since its discovery. Man, oh, man. Yeah.

Like I said, many of the people who used x-rays and had studied radioactive elements had suffered or died from their exposure to radiation. Right. But I think it's really interesting that these people, the researchers who worked on this, weren't actually the first to experience this. that prize goes to some miners in Schneeberg, Germany, who for as long as people could remember, had gotten sick with a mysterious lung ailment. Later research showed the mine to be full of radon gas, which is produced when radium decays,

and so is a source of radiation. Wow. Uh-huh. So they all had lung cancer at a time when lung cancer wasn't as common as it is now. Wow. And so that was sort of a pre-X-ray thing, but those mines full of radon gas weren't the only radioactive workplaces. Fluorescent paint containing radium glowed in the dark, which made it perfect to paint the numbers on a watch face so that people could tell the time in the dark. So in the early 1900s, wrist watches were largely worn by women while men used pocket watches.

But World War I changed that because you needed to see the time in a trench. You needed to have one. It was much faster to just look at your wrist rather than pull something out of your pocket, which could easily be lost. And so these glow-in-the-dark wrist watches with the numbers painted made coordinating night maneuvers possible. Wow. And World War I, once it was over, also made these watches like the thing to have. Like they were super popular.

one had to have one. I mean, demand absolutely skyrocketed. And so these watch factories were a great place for a young woman to work at the time. You were paid by the dial. So if you were a fast painter, you could make up to $24 a week, which is $317 in $2015. And that was at that was at a time when the average weekly wage for a woman was $15. Okay. So it was good money. It's good. good money. Factories popped up all over in New Jersey, Illinois, Connecticut. And it was in Connecticut where a 17-year-old named Francis Slutjocker had started working in 1921. Four years later, Francis went to the dentist complaining of facial pain and toothaches. The dentist pulled a tooth and a piece of her jaw came out with it. The tissues in her mouth basically at that point

started to deteriorate. A hole appeared in her cheek, and a month later, she was dead. And unfortunately, her story is not unique, not at all. All over these factories, dial painters were getting sick and dying, earning them the name Radium Girls, which is an excellent piece of nonfiction. You should definitely read it. Apparently, it's also a movie, but I haven't watched it. I've heard of it. Yeah, I haven't seen it either. Oh my gosh, the book is so good. Okay. One of the keys to being a good dial painter was that, have you ever tried to paint like fine? You have to keep the bristles get so smudged so easily and you have to keep them together. And so in order to keep that brush point super sharp to paint accurate numbers, you would put the tip of that paint brush in your mouth and twist it. Oh no. Mm-hmm. If you did this, which, by the way, was a technique taught at the factories.

Oh, no. Like, this is what you should do. Yeah. You would end up consuming about a coffee cup worth of radium-containing paint over the course of a year. You would literally sometimes come home and your clothes and your body you would glow in the dark because of the radium dust. Oh, my God. Mm-hmm. The fluorescent dust.

And while a lot of this radium would end up being passed through the gut, about 20% of it would be absorbed in the bones, essentially leading to a radioactive skeleton. And the jaw was one of the places, of course, first because you're putting it right near your mouth. And the blood supply, too, is just going to go straight into those bones right there from your... Oh, no. Mm-hmm. And so this led to an unbelievable amount of these radium girls becoming sick and dying or permanently disabled or injured by this radiation exposure. Oh my God. And the companies fought and fought and fought to acknowledge that they did any wrong to enact safety measures and to give any sort of compensation to the girls or the family.

of the girls. Surprises me not at all, Aaron. Oh, I know. I know. But, but, y'all. Eventually, a handful of the women got some compensation. Jesus. But at any amount of time, about 2,000 women were working at these factories. Oh, my God.

With a substantial portion of those getting sick. So the Radium Girls story is this horribly sad reminder of how a company can value greed and the bottom line over the health and safety of their employees, because they viewed them as dispensable. But I think it's also inspiring in a way because despite being ignored and told they were faking it and being told, no, you have no right to argue this, despite literally nearly dying of radiation sickness while giving their testimonies in the courtroom, these women fought and fought and fought and eventually won the battle that they should never have had to be a part of.

It's a really great book. So while the biggest obstacle in the way of the Radium Girls was the, I think, evil is a fair word, company, evil company that refused to acknowledge their wrongdoing. Another challenge was fighting against the popular opinion that radiation was this miracle cure. Because that was just sort of how it had been advertised. Like name any household product. and you could probably get a radioactive version of it in the 1910s, the 1920s, into the 1930s. Weird. Low levels were thought to be beneficial for overall health.

Okay, cool. Yeah. And any negative outcomes from larger exposures were thought to be relatively short-lived. Okay. I just don't, yeah. The opposite is true, but. Yep. One medication, medication is in quotes, called Radithor, was similar.

Simply radium dissolved in water. Oh, no. That's it. It was prescribed to people to help them heal after a broken bone. Okay. Uh-huh. Uh-huh. Yep.

So one of the people who had been prescribed Radithor was a golfer named Eben Byers, who drank over 1,400 bottles of Radithor. And he eventually developed holes in his skull, and he lost his jaw. and his body is now in a lead-lined coffin to protect people who visit the cemetery from getting radiation from him. Oh, my. Mm-hmm. And fortunately, I think the other thing to point out is that radium-containing medications didn't cause an epidemic of radiation poisoning necessarily, mostly because the vast majority of these treatments contained no radium at all.

They were snake oil medicine? Yeah. Because the ones that actually did were too expensive for most people to use regular. Oh, gosh. But radiation was also used to, like, irradiate hair. Like, oh, you want hair removal? Let's irradiate your, you know, upper lip. And then your upper lip falls off.

Uh-huh. Like, the hair will be gone, too, but. Yeah. They wasn't false advertising necessarily. Right. Oh. It's effective, but. Mm-hmm.

So early in the 20th century, those that worked with radiation were well aware. of these hazards. But what was more difficult to determine was what levels of radiation were necessary to cause harm. Right. And a big, you know, a big challenge or a big hurdle was not having a standardized way to measure radiation exposure, but that sort of is a whole separate story. But eventually standards were put into place for the safe level of exposure to radium and x-rays and gamma rays. But debates over whether these standards were accurate continued. And when the Manhattan Project to develop the atomic bomb began, it was clear that more fine-scale information on the dangers of radiation exposure was necessary for the researchers to understand their level of risk. After all, two researchers died in two separate instances in the Manhattan Project after experiencing a massive dose of radiation when an experiment went wrong.

But where would they get this information on radiation exposure? Well, for one, the atomic bombs themselves. Okay. The catastrophic impact of the atomic bombs dropped by the U.S. on Hiroshima and Nagasaki without any warning in World War II was not just the enormous loss of life from the direct impact of the bomb, but also in the lingering effects of radiation sickness that would only be felt weeks, months, and years after the bombs. I mean, the trauma is immeasurable. Yep. And a lot of what we know today about the harmful effects of radiation on the body, both acute and chronic, come not from early occupational exposure to x-rays or radium, but from these bombings.

In the Red Cross Hospital in Hiroshima, only six out of the 30 doctors and 10 out of the 200 nurses were able to. to function after the bomb was dropped. An estimated 90% of Hiroshima's doctors and nurses had been killed or injured by the bomb. The 600-bed hospital was completely unprepared for the 10,000 bomb victims that would head there that day alone. Many of these people would die, vomiting and with burns all over their bodies, and many others would be left with this insidious internal radiation injuries whose effects would only manifest later on in their life. And the world had never seen radiation illness on this scale before. And the doctors at the hospitals in Nagasaki and Hiroshima were unprepared to deal not only

with the sheer number of people needing help, but they also didn't even know how to help them because no one had told them anything about radiation. No one had ever experienced anything like this before. Right. And like you said, there were no treatments. There's no treatments. Yeah. Yeah.

There's nothing you can do. Yep. The number of people killed in Hiroshima is not quite certain, like how many were actually just vaporized by the bomb and didn't survive the initial blast. But estimates range from 90 to 165,000 deaths. About 75% of those died from fire and trauma, and the other 25% died from the direct effects of radiation. And that's like the immediate death toll. Immediately. Right. Yeah. And then once those three waves of death had ended, it was just a waiting game to see how

radiation poisoning would continue to manifest in those who had been exposed. In both Hiroshima and Nagasaki, one of the health outcomes of these bombs wouldn't be seen for several years after the bomb had been dropped, leukemia. And it turned out that the rates of leukemia among atomic bomb survivors were skyrocketing. And soon it became apparent that other types of cancers were also on the rise, and the effects of the bomb would continue to be felt for decades and decades. To some of the people in power in the U.S., a lot of the people, one might say, these bombings were viewed as an absolute win.

Not only did they result in the absolute surrender of Japan and the end of World War II, but they also provided this fantastic opportunity to see how different doses. and types of radiation impacted people. It's horrible. So the U.S. immediately sent physicians to Japan to study the effects of the bomb and write down what they witnessed. And what they witnessed obviously horrified them. They had expected to see acute radiation poisoning. They had seen that before.

But the increase in cancers later on and the huge geographic radius of fallout, like so much larger than they anticipated, was new. And so the word fallout, just to define it, is radioactivity that settles to Earth's surface from the sky. So, like, if you drop the atomic bomb, all of that dust and dirt and debris that goes up into the air and then settles down is radioactive. And that can cover a much larger radius than, like, the direct impact of the bomb itself. That makes sense. Yeah, absolutely. But these doctors who went to Japan, they couldn't make these horrible observations.

is known because maintaining trust in the government and a positive image in radiation and nuclear weapons was cited as a reason to not be forthcoming about the risks involved in nuclear weapons testing and the horrors involved nuclear weapons deployment. And other people viewed widespread fallout from nuclear weapons testing a small price to pay for advancement of technology and global superiority of the United States. Erin, this is not... It's awful. It gets worse.

Yeah, of course it does. This podcast will kill you. Yeah. After the atomic bomb was developed, the U.S. continued working on making a bigger and better bomb. The U.S. decided to use Bikini Atoll, which they took control over from Japan after the end of the war to use as a nuclear weapons testing grounds. One day, as the entire community of bikini islanders were leaving church, so around 160, 170 people, the U.S. military governor said, hey, the U.S. needs your island for important research, so you're going to need to move to another island. And so they moved them. Even though archaeological evidence showed that this island had been inhabited since 2000 BCE, colonialism doesn't care. Colonialism does not care.

There's a documentary called Atomic Cafe, which shows some footage. It's such a fascinating documentary. Holy cow. It's from the early 80s. And they show footage of like propaganda footage of the U.S. military, you know, this very paternalistic white savior colonialism like, you know, we're doing what's best for you. And don't you want the world to be protected from nuclear weapons? It's so gross, dude.

they're using too. We're doing what's best for you and... That's exactly right. We know exactly what's right for you, so give us your island and we'll make the world a better place. That's, I mean, honestly, I think you just watched the documentary. You just quoted directly from it. Thank you.

So anyway, with these, with now the island empty for their own use, the U.S. was able to test the hydrogen bomb on March 1st, 1954. This bomb produced a fireball four and a half miles in diameter. That's just the fireball alone. That's the size of the town that I live in. It was visible over 250 miles away, and it produced a crater over a mile wide and 250 feet deep. The mushroom cloud was 25 miles high and 62 miles in diameter.

It's huge. It's huge. Oh, my. Nearly 7,000 square miles of the Pacific Ocean were contaminated, which is far beyond, far beyond what the U.S. calculated it might be. Shock of all shocks. It was probably like, oh, well, it'll be fine. Everything's fine. Everywhere, everywhere the ground was contaminated, marine life was contaminated, reefs, fish, people,

died. And unfortunately, the U.S. missed in their scans a Japanese fishing vessel who happened to be in the direct proximity of this. The fishermen were close enough to see this blinding light and hear the blast. And they started showing signs of radiation poisoning shortly after returning to shore. All the fish that they had caught with them and sold at the markets was full of radiation. People started experiencing radiation symptoms who had purchased the fish and ingested it, etc. Oh, my God. And the U.S. soldiers who were present also experienced both short and long-term health consequences from this and other weapons testing. And they weren't told about the risks.

They were just said, stand in place. They're soldiers. They're just supposed to stand there and do what they're told. Mm-hmm. And, you know, but ultimately the U.S., the people in charge viewed these as unfortunate consequences and a small price to pay for the advancement of technology. Small price to pay, human lives, NBD. And the sad story doesn't end there. The bikini islanders ended up suffering malnutrition on the smaller island that they had been relocated to.

And later tests showed dangerously high levels of radioactive elements in their bodies and in the food that they consumed. And so in 1980, the atoll was entirely evacuated. Which is, like there are so many levels of horrificness. to that. You know what I mean? Like it's forcibly removing people from an island they've inhabited for thousands of years, absolutely decimating their culture. Now you can't eat the food that you've been eating because it's all radioactive. Now you can't even live anywhere on any of these islands. Oh, and by the way, you're all going to die from radioactivity poisoning and develop

cancers down the line. Mm-hmm. I hope that you have it in you to, hear a little bit more of the dark side of this. I mean, and the thing is, like, I think it's really important to tell these stories because one of the things that I, you know, I wrote down in my notes was like any one of us who is doing any sort of job, particularly in research, where does our information come from? Where did we get this knowledge when it comes to medicine, when it comes to ecology, when it comes to chemistry, when it comes to physics? What lives? What lives? were sacrificed unknowingly unwillingly, at what cost?

At what cost? To make sure that we don't do it again. Yeah, I agree entirely. I think it's so important to know where we got this information. Because you can talk about what we know about the symptoms of radiation poisoning. But if you don't understand how we got that information, then you're missing such an important part of the story. The humanity part of it, which is the only thing that keeps, you know, like we need to keep that

sense of humanity so that this doesn't happen again. Mm-hmm. Mm-hmm. Yeah. So the atomic bomb victims in Japan, the Marshall Islanders, the American soldiers ordered to stand at varying distances from test bomb sites, the people in fallout regions, these were all unwilling and unknowing participants in the search for information on how radiation affected the human body.

Mm-hmm. But they weren't the only ones. Earlier, when I asked how researchers would get information on radiation exposure, if you had guessed human experimentation in addition to nuclear weapons, you would be correct. Yes, by U.S. scientists, yes, often without the people's knowledge or consent. I highly recommend the book, The Plutonium Files, for more information on these horrific examples of medicalized torture. which, so someone pointed out on Insta that that's what people are using in place of the words experiment or study for these types of things since those words experiment or study can give them this air of legitimacy.

Oh, that's really, that's so important. It's a good point. Yeah. So during the last couple of years of World War II and throughout the Cold War, the U.S. was involved in a multitude of different medicalized tortures or I don't know how the plural of that is, but to examine the effects of radiation. For instance, plutonium was injected into people without their knowledge or consent. Yep. These people were followed for years and years surreptitiously by the researchers, and when they died, samples from their bodies were taken, often without consent

from the family. This was in what year? This was, uh, I don't know when the, I don't know when the, I don't know when the first injections were it might have been in the late 1940s, but throughout the 50s and 60s, into the early 90s, the last person died in the early 90s. When we knew the effects of radioactivity for decades. But what about plutonium compared to uranium? Yeah. Let me guess what these people looked like. Oh, yeah.

Yeah. It was always disproportionately minorities, people who were below the poverty line. children who were disabled orphans. Oh, yeah. Oh, my God. Like I mentioned, some of the children who lived at orphanages or children who were disabled were fed radioactive milk to see how that affected their growth,

since, according to at least one scientist, samples from children were far too few and far between. So, Willard Libby, who was the head of the Atomic Energy Commission during the time. This was in the 50s, I think he said this. Quote, I don't know how to get them, but I do say that it is a matter of prime importance to get them, referring to samples, and particularly in the young age group. So human samples are often of prime importance, and if anybody knows how to do a good job of body snatching, they will really be serving their country. That's a quote from who was the head of the Atomic Energy Commission at the time.

Prisoners had their testicles irradiated, often without their consent or without at least informed consent, rendering them sterile and often resulting in cancer. And then, you know, what does consent really mean if you're imprisoned? If you're in prison. Pregnant people were given injections of cesium to see whether radioactive, elements could pass through the placenta to the fetus. Mm-hmm. And as we talked about, the people who were sought out to perform this medicalized torture on were those who didn't have the power, the voice, the ability to stop what was happening.

They weren't deemed to be worthy of being protected by the scientists and project heads, the perpetrators of these crimes. And of course, there were disproportionately high numbers of black people and poor people, unknowingly and unwillingly enrolled in this medicalized torture. Throughout the Cold War, body parts from an estimated 15,000 humans were used in this quote-unquote research, according to a 1995 General Accounting Office study. So bodies or organs or tissue samples were taken from people without any consent from their families, and much less, you know, they didn't inform them, of course.

Of course not. In the U.S., all over the world, they would do. this. They would ship internationally specimens, especially from the poorest regions of the world. Read up on Project Sunshine, which was the largest of these projects. That's a disgusting name, because Sunshine is something beautiful. Isn't that horrible? So one of the theories as to why it was named Project Sunshine is because like Sunshine, fall out from radiation impacts the entire world. Well, it's also, sunshine, like, it sounds like beautiful and happy, but it also has UV radiation, which can cause cancer and kill you. There you go.

It's insidious. Mm-hmm. Wow. And I think it is important to consider the historical context of this time. And this is the opposite of excusing it. So at the height of these studies, the world was barely 10 years out from World War II and Nazi Germany and the horrible human experimentation and medicalized torture that went on and the Nuremberg trials during which many of these Nazi doctors were put on the stand and made to account for their crimes. And yet, when conducting this medicalized torture on people,

these American researchers and doctors involved in Project Sunshine and other radiation projects didn't for once think that they were in the wrong. To a great many of them, the Nuremberg Code was written for barbarians, not for them. They were doing this research. for a higher purpose, for the technological superiority and might of the United States. And upon reflection of this time, one doctor involved in the project said, quote, the connection between these horrendous acts and our everyday investigation was not made for reasons of self-interest to be perfectly frank. As I see it now, I am saddened that we didn't see the connection, but that was what was done. We wrapped ourselves in the flag.

Which is such, such. Saddened. That's it. I'm just saddened. How regretful. Yeah. Whoops. My bee.

My bee. Wow. Mm-hmm. Okay. So, yeah. I mean, there's a lot more where that comes from. Uh-huh. Please go read the plutonium files.

It is an incredible book. Anyway, okay. Oh, gosh, Erin. So, yeah. A lot of what we know about the effects of radiation, on the human body come from atomic weapons or come from this medicalized torture. And while a great deal of this medicalized torture was not at all therapeutic, as in the doctors weren't trying to improve the health or treat the disease of someone, it was just to see what

happened. But some were actually intended to help people. And so I'm going to end on what I hope is a little bit of a happier. note by talking about the development of radiation therapy. Okay. Let's see if we can get there. I know. So in the early years of radiation therapies, most were actually snake oil, as we pointed out,

just designed to make money. Snake oil still exists today. Goop. But some physicians began to recognize that while radiation can cause cancer, it may also be able to treat it as well. And this is super early on too. This is a great story. So a man named Emil Grubb was simultaneously the owner of a light bulb company and a med student.

Like you do. Like you do. So he showed up to med school one day with his hands all bandaged up. And one of his professors was like, are you okay? What happened to you? And Grub explained, oh, yeah, I'd been working on x-rays at this factory, just like, you know, testing things out. And the professor, whose name John Gilman, was like, hmm, so X-rays are damaging to normal tissue. I wonder if they would damage or destroy disease tissues as well.

Like, and then thus the field of radiation oncology began. Wow. 1896. It's like months after they were discovered. A month. A month after. Wow. Two days after his professor made this remark, Grubb decided to take.

tested out on people with cancer. And again, probably, you know, there wasn't informed consent or consent at all. A lot of the people that he initially started with, there was big resistance to allowing him to do this to people who had cancer but maybe not terminal cancer. And so the earliest people that he tested it on were people who had terminal cancer. Okay. That makes a lot of sense. It makes sense.

and their pain did seem to be reduced, but a lot of them died anyway, simply because they were in such late stages of cancer. But Grubb wasn't discouraged. Doctors would send him people with late stage cancer. Grub would continue to blast them with x-rays. Most died, but some actually did seem to be improving, which is amazing. Like, this was 1896. That's incredible. This is before basically any effective medical interventions had been.

developed before antibiotics even. Wow. Yeah. At the time that radiation therapy began to be developed, the biology of cancer hadn't even been fully clarified. Wow. It's amazing. And obviously, there was a trial and error process to find the right dose to kill cancer cells without killing the patient, doing a better job of targeting the affected area, and overall standardization of equipment. At first, radiation therapy was used primarily on tumors close to the skin surface, which is where it seemed to have the best effect because that way you're not trying to penetrate too deeply into the body. And tumors deeper in the body didn't seem to decrease as much as well.

So we know now why that might be, but Alexander Graham Bell said, he said he thought it might be because the radiation had to travel through layers of healthy tissue. cancer's tissue is more susceptible to radiation, before it got to the tumor. And he then suggested that, quote, there is no reason why a tiny fragment of radium sealed upon a fine glass ampule should not be inserted into the very heart of the cancer, thus acting directly on the disease material. We do that. We do that.

Brachytherapy. That's like widely used today. Yeah, wow. How cool. Isn't that amazing? Yeah. Anyway. So in the early history of radiation therapy, x-rays took a backseat to radium and radon. The x-rays produced from the x-ray tube couldn't penetrate tissue very well, and their application seemed limited. But then the physicist developed something called the linear accelerator, or linac. I think that's how you say it. Which could produce higher energy x-rays than those that came from these x-ray tubes. And one of the first clinical trials to use the lin- was for Hodgkin's disease, a type of cancer that is very localized in lymph nodes, often deep

within the chest. And the people in the trial had well-defined early-stage Hodgkin's disease, which was crucial to the success rate of the treatment. Since later stages could mean that the cancer had spread out of the target area. The trial was a huge success. 50% of the people with Hodgkins had been cured, and that rate continued to increase. Wow. Yeah. That's really cool. It's super cool. The development and successful application of the Lenach was also an important lesson in choosing the right therapy for a person, since cancer is not a catch-all disease. It's not a one type of disease. It's super variable. Even when you're talking about the same type of cancer, you're going to have different manifestations, different areas, and you can't not all treatments are created equal. That's why it's so hard to treat still today. Still today, yeah. And it's also why now today, you know, we have some cancers that are treated with radiation and others with chemotherapy or maybe a combination or in different times or surgery.

Yep, or all three. Or all three, yeah. And another big step forward in radiation therapy was when a researcher named William Bragg discovered that there was a big burst of energy released just before an alpha particle reaches the end of its track. This is now called the Bragg Peak. Okay, what does that mean. It's important because you can use this Bragg peak to more precisely target a tumor and avoid the surrounding healthy tissue. And because of the super high specificity and efficiency in tumor killing, proton accelerators are apparently now being installed in clinics all over. How cool is that? That's very cool. I love it. I love it. Okay. So that was a quick and dirty history. I didn't talk much about the whole body radiation that was performed on people without

their consent, all in the name of, oh, this will help you. Mm-hmm. No. Sure, sure. Yeah. Basically, this is just a read more books to learn more. But anyway. It's an intro. It's an intro. Yeah, this is a, not even a primer. It's a very surface level. Yeah. But it, I mean, it is true that we have come a very long way from the early days, of Rontgen playing around with crooks tubes and from injecting plutonium into people without their knowledge or consent. Radiation therapy is incredibly powerful and so much safer than it once was. But other things like Three Mile Island and Chernobyl and Fukushima aren't so far away. And I had been planning initially on talking about these meltdowns a little bit, but I

realized I just couldn't do them justice. Don't worry, I'll recommend books. And I'm definitely not equipped either to go into the pros and cons of nuclear power plants. But I do want to say that the thing that I, that one of the things that I've taken away from all this reading about radiation is that it seems to have unlimited potential, potential to do good and potential to do harm. And like some of the poisons that we've talked about in these episodes, so radiation is this Janus-like thing, this just duality of nature. It's good and bad. And so radiation. And, like, dose dependent, et cetera, et cetera, you know. And I don't really know how the scales are currently tipped in terms of the good or bad, probably bad. But I think we do need to fight very hard and to

be very vigilant to make sure that the harm doesn't outweigh the good. Yeah. Or won't outweigh the good in the future. And I think the story of radiation also serves, like I said before, is this very important reminder to think about where our knowledge comes from. and at what cost. So we don't make these same mistakes again because they're probably still being made right now. I mean, we're just not going to learn about it for 30 years. Right.

That was 2020 and then we'll be more horrified than ever. Mm-hmm. Anyway, so, Erin, tell me some good stuff, question mark, about the use of radiation today. We might end on a note right after. Right after this break. I don't know if this is going to be a happy or a sad note to end on, but it is, it's a note. And so this is how I've decided to end this episode is basically to just kind of talk about how we use radiation in medicine today.

Like where do we see it? How do we use it? Because I think like you said, of course, understanding where this knowledge came from is so important. And moving forward, understanding the risks and benefits. I think is super important in terms of how we use radiation. Because it does sound scary, right? The word radiation sounds scary. Yeah. So how scary is it? So where do we use radiation in medicine today? A few different things. We use radiation for diagnostics. So is your arm broken or not? We use an x-ray to see that. Do you have diverticulitis? We can use a CT scan to see that. So that's diagnosing.

If you come in with a disease or an illness or a problem, we can use radiation to try and diagnose that problem. We use radiation for screening, which is a very interesting and potentially controversial area to use radiation. Yeah, all about like, yeah. Okay, are you going to talk about that? We can talk about it. Yeah, absolutely. Okay. But so we use radiation and screening. That's like, for example, a mammogram.

Okay, so a mammogram is a CT scan of your breasts. So we can use that to look at the tissue to see, to screen, which means screening is essentially using these tools in healthy people with no evidence of disease. That's what a screening tool is. Right. to see if you have evidence for concerning for breast cancer. Okay, that's an example of radiation for screening. And then we also use radiation for therapy, right?

We use radiation for therapy for cancers. I think those are kind of the three big areas that we use radiation in medicine today. So let's kind of talk about what are the risks of radiation overall, and then we can talk in a little more detail about those three areas. Cool? Because the risks and benefits are, of course, different in all those three scenarios, whether you're talking about diagnosing something

where you come in with something wrong versus screening healthy people versus treating a potentially fatal disease. Okay. So overall, the biggest long-term risk of radiation exposure, long-term, is cancer. which we've talked about. So what is that actual risk, like per unit exposure? Luckily, Dr. Jorkinson, in his book, told me this, okay? If you calculate it per unit of ionizing radiation,

the risk of cancer is 0.005% per millisevert of whole body radiation. that's what your risk of cancer is per one millisevert exposure okay and this is like a cumulative exposure yeah it's cumulative absolutely okay right so let's put some more concrete numbers on that because that's too tiny to talk about okay a whole body spiral CT scan CT stands for computed tomography I think but it's basically x-rays that they go in a circle around your whole whole body and take tiny, like, pictures of tiny layers of your whole body. So it's a relatively large dose of x-rays compared to, like, an x-ray of your arm. A whole-body spiral CT would expose you to 20 milliseconds of ionizing radiation. Okay. So that would be a 0.1% increased

lifetime risk of cancer, aka 1 in 1,000. So of 1,000 people that get a spiral CT scan, one of them is expected to develop cancer as a result of that spiral CT. Gotcha. Okay. And so two questions. Okay. One, how does age play a role in this in terms of making decisions? Okay. And number two, what about background radiation, like what we experience on a daily basis? Okay, listen, Aaron, your questions are great, but they're totally getting ahead of the point, Okay. Sorry, I'm too excited. Yeah. No, those are the exact questions that you should be asking when you think about radiation, right? Because we can't look at exposure to a CT scan in a vacuum because medicine is not the only place that you're exposed to radiation, right? We're exposed to it every day. And you also have a baseline risk of cancer, whether from environmental radiation or from genetic predisposition or from other exposures, everyone has an overall. risk of cancer, right? Exposure to CT scans is not the only thing that causes a risk of cancer. Okay? So we can't look at it in a vacuum. So let's talk about kind of what the overall lifetime

risks of cancer are to get an understanding on how this CT scan increases that risk. Okay. Okay. It turns out that in the U.S., this is from cancer.gov, the lifetime risk of developing a cancer is overall about 40%, which is pretty high. About half of all males and one in three females will develop some type of cancer in their lifetimes. Wow. And that's not including, by the way, basil and squamous cell carcinoma, which is like the skin cancers that aren't invasive. Or aren't related. Yeah. Holy cow. And the risk of dying from cancer overall in the U.S. is about 20%. Okay. It's really high. So I just keep saying, wow, like Owen Wilson. Wow. I'm sorry, but like,

wow. Holy cow. It's really, really high, right? So if your overall average risk is 40%, and you increase that by getting a spiral CT to 40.1% is that significant? Right. What is the threshold at which we declare something too high of a risk. Exactly. And the thing is, that 0.1% is significant to that one person who develops cancer from that spiral CT scan. Uh-huh. But then there's 999 others who 40% of them are going to still get cancer from some other source. And maybe even that person who might have developed cancer from a spiral CT got cancer from something else instead. Mm-hmm. Okay. So, Yeah. And this is something that makes it really difficult or maybe at least really complicated to quantify the risks and benefits, especially when you think about the three different areas that

we use radiation, screening versus diagnosis versus treatment. Okay. Uh-huh. And so, oh, the threshold is different. If it's for treatment, you're going to want to push the start button on radiation earlier than you would necessarily for screening. Because the benefit is a lot greater for treatment of a potentially fatal cancer. So yes, there might be a risk of you going on to develop a secondary cancer, but the benefit is you're going to kill that breast cancer that you already have that's going to kill you in the next five years, right? Right. It reminds me of how antibiotics are easier to test than vaccines. Yes, exactly. Exactly.

Therapeutic versus preventative. Therapetic versus preventative. And the other thing is, even that number 40%, okay, 40% lifetime risk of developing a cancer in the U.S., that's an average. For some people, that risk is going to be a lot higher, and for others it's going to be a lot lower. And this will depend not only on, like you mentioned, Erin, your age, but also your genetics, the area that you live, like how much, maybe your occupational exposures.

For example, if you have a BCRA, a BRCA mutation, that's the breast cancer mutation, your lifetime risk of breast cancer or ovarian cancer might be over 80%, which is really high. If you have a mutation in a gene called APC, that leads to a disorder called familial adenomatous polyposis, your risk of colon cancer is 100%. Like everyone with that genetic mutation is going to get colon cancer and has to have their whole colon removed prophylactically. So they don't die. Oh my God. So versus someone else who maybe for one reason or another might have a very low lifetime risk of a certain type of cancer. Okay. And, okay, it gets even better. This is fun.

The other thing is that overall in medicine, our use of radiation has been increasing. While the dosages that you're exposed to in a single x-ray or a single CT scan are vastly lower now than they were when we first discovered x-rays, for example, like per unit, they're really, really small doses. Overall, we're using them more and more often. but we're not using them equally. That makes sense? Oh, yeah. Oh, gosh. So it makes that, again, even more difficult to overall balance the risks and benefits.

So when you're thinking about, do I need this test that involves radiation, you have to think about how much radiation have you been exposed to in the past or has if you, if you are. are the one ordering the test, how much radiation has this person been exposed to in the past? How often have they gotten these types of scans? What types of scans are they getting and how much radiation is it exposing them to? Because an x-ray of your broken wrist is a lot less radiation than a CT scan of your head and neck or your abdomen and pelvis, right? Mm-hmm. And what are we using it for? Are we trying to diagnose a broken wrist that we really need to treat?

are we trying to screen for breast cancer that this person maybe has a very low lifetime risk of overall, or are we trying to screen for a breast cancer in someone who has a genetic mutation that makes them very susceptible to breast cancer? Right. It's a very individual question. You have to consider the context. It's very individual. So breast cancer is a really interesting example because there is no consensus guidelines on how often, depending on who's website you look at, whether it's like the, like the Cancer Society versus the Breast Surgeon Society versus the United States Preventative Health Task Force, they have different guidelines on who needs to be getting mammograms and how often and how old to start them. Mm-hmm.

Right? Because it's difficult. It's kind of, it's a very individualized decision. So, yeah, I don't know. I mean, that's kind of, that's all I have to talk about in terms of how we use radiation today. But I think it's really interesting. And I do think the most important thing to keep in mind is thinking about the risks and benefits depending on the scenario in which you're using radiation. Totally. Yeah, it's super context dependent. It's really interesting. Yeah.

Interesting. Yep. Brin-new. Oh. Oh, all right. Well, should we cite our sources for this episode? I'm going to guess there's going to be a long list of them. Mine's like all books this time.

I didn't even have time for the articles and documentaries. But okay. So first, strange glow, the story of radiation by Dr. Jorgensen. It's great. It was awesome. Like such a good book, super interesting. And then like I said, I didn't talk about Chernobyl at all or Fukushima. But I did read a couple of books about Chernobyl.

So the first is called Midnight in Chernobyl. The Untold Story of the World's Greatest Nuclear Disaster by Adam Higginbotham. Such a good book, really fascinating. And this also is what the show Chernobyl, which is excellent, took a great deal from. And then the other thing that I really want to mention about Chernobyl is a book called Voices from Chernobyl, which is an oral history of the disaster by Svetlana Alexovich. And then The Radium Girls, of course, by Kate Moore. Great book about that struggle and the occupational exposure to radium-containing fluorescent paint.

And then Robert Jung, brighter than a thousand suns, a personal history of the atomic scientists. I read that a long time ago in college, but it was really interesting about the Manhattan Project. The plutonium files, which is what I talked about, the America's Secret medical experiments in the Cold War, so good. that is by Eileen Wellesam. And then also Harriet Washington's Medical Apartite has a lot of discussion about this as well. And then finally, I'll recommend a documentary called Radio Bikini and a documentary called Atomic Cafe. Watch those. They're both on YouTube.

Read those books. There's more, definitely more than what I was able to tell. Strange Glow also has a ton of information both on the current U.S. uses of radiation in a medical context and the like biology of radiation. But there's a couple of other good articles that we will link to on our website where you can find all of our sources from this episode and every single one of our episodes. So definitely check those out. And we also have a bookshop.org affiliate link program.

If you'd like to purchase any of the books that we recommend, we get a small commission from that. and you can check out our Goodreads list, which just has recommendations. Yep. Thank you again so much to Dr. Jorgensen. We really appreciate you taking the time to chat with us and explain radiation. Yep. And thank you also to Bloodmobile, who provides the music for this episode and all of our episodes.

And thank you to our listeners. We love you. We appreciate you. We hope that you enjoyed this episode. Yeah. All right. Well, until next time, wash your hands. You filthy animals. This is Special Agent Regal, Special Agent Bradley Hall.

In 2018, the FBI took down a ring of spies working for China's Ministry of State Security, one of the most mysterious intelligence agencies in the world. The Sixth Bureau podcast is a story of the inner workings of the MSS and how one man's ambition and mistakes opened its fault of secrets. Listen to the Sixth Bureau on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. I'm Amanda Knox, and in the new podcast, Doubt, the case of Lucy Lettby, we unpack the story of an unimaginable tragedy that gripped the UK in 2023. But what if we didn't get the whole story? Evidence has been made to fit. The moment you look at the whole picture, the case collapsed.

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