Two Sides of a Coin: Nuclear Weapons and Nuclear Medicine

“There‘s always two sides to the coin if you have the patience to see.” 

—Kathryn Budig

When the study of nuclear science started, the world was quite unaware of the possibilities it held. No one had foreseen the massive destruction that nuclear weapons caused or the numerous advantages nuclear medicine has given us. The world’s first nuclear weapon exploded on 16 July 1945 in New Mexico when the United States tested its first nuclear bomb. While nuclear medicine gained public recognition as a potential speciality on 11 May 1946, when an article was published in the Journal of the American Medical Association (JAMA) about the successful use of radioactive iodine in treating Grave’s disease. And after observing the two sides of the coin, we are left with the ethical dilemma about the use of nuclear science to date. 

Use of Nuclear weapons and Its Consequences

The first nuclear attack occurred soon after the first nuclear bomb was tested. The United States dropped two atomic bombs on Hiroshima and Nagasaki on 6 and 9 August 1945 respectively. It has been 75 years now and thankfully, these two Japanese cities have recovered to a great extent. But, it was estimated that almost 90,000 to 1,66,000 people in Hiroshima and 60,000 to 80,000 in Nagasaki lost their lives within a few days of the bombing, although it’s just imprecise estimates because according to reports, there were many people whose complete families were wiped out and no one was left to report their deaths. 

Other than this, it was expected that these ionizing radiations might have acted as mutagens and would have increased the likelihood of mutations. There was not just one but many long-term health effects of the radiation, the most important being Leukaemia. It was observed that after a few years of the bombing there was a great increase in leukaemia cases, especially in children. Even if we ignore the various physical health impacts, there are many mental health impacts the survivors have suffered, from losing everything to the attack to being discriminated against, the survivors have seen it all. 

In their culture, they are known as ‘hibakusha’, although it means a person affected by a bomb or person affected by exposure but many consider these people to have devil’s blood. These people are looked down on and treated indifferently on many inappropriate grounds. This is the only nuclear attack we can discuss because fortunately proper regulations were made to keep a check on the use of nuclear weapons. But there had been many radiation disasters like the Chernobyl disaster, etc., reminding us time and again about the threats, the use of radioactive materials and nuclear science can pose.

Nuclear Medicine and Its Applications

While we discuss the threats, we also need to flip the coin and see the benefits of nuclear science in medicine. We have been aware of the use of nuclear medicine for about a century now but it’s only been a few decades since it has become popular. It holds a lot of potentials. It is a specialized field of radiology that uses small amounts of radioactive materials or radiopharmaceuticals to examine organs. It uses various radionuclides like technetium, thallium, gallium, iodine, and xenon. These radionuclides are selected based on the organ which is to be examined. These radionuclides are given to the patient, it gets collected in a particular organ, after which radiations are given off. This radiation is then detected by a radiation detector.

The behaviour of radionuclides is measured in the organ and is used by healthcare providers to assess and diagnose various abnormalities. One of the particular scans using radionuclides is gallium scan, it is used to diagnose active infectious and inflammatory diseases, tumours, and abscesses. Nuclear medicine is also used therapeutically like Iodine-131-sodium iodide is used to treat hyperthyroidism and thyroid cancer, Yttrium-90-ibritumomab tiuxetan (Zevalin) and Iodine-131-tositumomab (Bexxar) is used to treat refractory lymphoma, ¹³¹I-MIBG (metaiodobenzylguanidine) is used to treat neuroendocrine tumours, Samarium-153 or Strontium-89 is used to treat palliative bone pain treatment and Rhenium-188 is used to treat squamous cell carcinoma or basal cell carcinoma of the skin, etc. 

Adverse Effects of Nuclear Medicine

A new branch derived from nuclear medicine is Brachytherapy. In this, a sealed radiation source is inserted inside or next to the area that needs treatment. It is used as a successful treatment for cancers of the cervix, breast, prostate, skin, and oesophagus. But this therapy technique has a lot of side effects both short-term and long-term that vary from minor bruising to urinary and digestive dysfunction. Many people also consider that this treatment can pose a threat of radiation exposure to people around them but nothing like this is true for either temporary or permanent brachytherapy. After temporary brachytherapy, no source of radiation is left in the body to cause risk, and even after permanent brachytherapy, the source of radiation is only enough to affect a few millimetres of tissue around it. 

Another problem with the use of nuclear sources is that even minor sources of radioactive materials can spread a great amount of radiation. These sources are known as orphan sources. Some examples include a radium needle found in a Prague playground in 2011, radiating 500 µSv/h from one meter away, a radioactive source was lost during radiography and taken home by other people who initially failed to recognize the source in Casablanca, Morocco, etc. These sources caused significant harm unintentionally proving that even though nuclear wastes are not as dangerous as nuclear weapons, but it still poses great risk. And the thing to notice is that most of these orphan sources were somehow related to the healthcare system.

Even after discussing all the risks and benefits of nuclear science, the dilemma remains. There seems to be no significant risk: benefit ratio, on which we can rely. It pretty much depends upon which side the coin faces when it hits the ground after being tossed and what you choose.

Precautions Taken at Global and Local Levels

Fortunately, today we have explored most of the possibilities that this field holds and are quite aware of how to protect ourselves from greater risks and enjoy the benefits. Many treaties have been signed at a global level to ensure that nuclear weapons are not used and to regulate their development and testing. The latest treaty that has come to force is the Treaty on the Prohibition of Nuclear Weapons, it had come to force on 22 January 2021. This treaty states a lot of points intending to guarantee that nuclear weapons are never used again under any circumstances. 

Other treaties that have been signed to regulate nuclear weapons include the Treaty on the Non-Proliferation of Nuclear Weapons (NPT), the Treaty Banning Nuclear Weapon Tests In The Atmosphere, In Outer Space And Under Water, also known as the Partial Test Ban Treaty (PTBT), and the Comprehensive Nuclear-Test-Ban Treaty (CTBT), which was signed in 1996 but has yet to enter into force. Other than this, there are proper regulations for the disposal of nuclear wastes, irrespective of their source of generation. It is important to dispose of nuclear wastes in deep geologic repositories. In India, every radioactive material user needs to take authorization from AERB (Atomic Energy Regulatory Board) for the disposal of disused sources or waste. These rules and regulations have made the use of nuclear science safe and more beneficial for the people.

Finally the proverb, ‘Better a thousand times careful than once dead.’, is very precise to the use and development of nuclear science.