Jerold M. Lowenstein's Blog

Radioactive Iodine in Health and Disaster

Radioactive iodine, an abundant by-product of nuclear fission, is used for diagnosis and treatment of thyroid diseases. Its release to the environment in nuclear accidents is a major concern.

            Iodine-131 was the first radioisotope to find widespread use in medicine. In my profession, nuclear medicine, the physics, handling, and applications of radioactive iodine are fundamental. The thyroid, a small gland located in the front of the neck, controls bodily metabolism and is the only organ that uses iodine. It makes hormones in which iodine is essential. Under-activity and over-activity of the thyroid are common and serious disease conditions. Iodine-131, with a half-life of eight days, is extremely useful in both diagnosis and treatment.

            In diagnosis, a tiny amount of radioiodine is given by mouth and its uptake in the thyroid measured by special instruments. In hypothyroidism (low function), the uptake is low, in hyperthyroidism it is high. A scan of the thyroid will show its size and whether the uptake is uniform or irregular. A "hot" area may be a nodule causing hyperthyroidism. A "cold" area could be cancer and may be biopsied.

            Before Iodine-131 came along, hyperthyroidism was mainly treated by surgery. Several other important structures lie in the neck close to the thyroid: the parathyroid glands that control calcium metabolism, the nerves to the vocal cords, and the blood vessels to and from the brain. In a small percentage of operations, damage to these structures leads to serious complications. Treatment of hyperthyroidism with Iodine-131 (in doses much more concentrated than those used in diagnosis) is very effective and does not damage the parathyroid glands, nerves, or blood vessels. Therefore, Iodine-131 has largely replaced surgery as the standard treatment for hyperthyroidism.

            But doesn't radiation cause cancer? That possibility was a major concern about Iodine-131 treatment. Hundreds of thousands of patients over many decades have showed no increase in thyroid cancer. To the contrary, the cancer rate among treated patients is lower than that in the untreated population. In some cases of thyroid cancer, there is still measurable iodine uptake, and, if surgery fails to remove all the cancer, these patients can be treated and often cured with large doses of Iodine-131.

            It was a surprise, then, after the Chernobyl meltdown in Belarus in 1986, that several thousand children developed thyroid cancer. The radioactive fallout had been concentrated in the milk of grazing cows. The children, but not the adults, who drank this milk had a higher risk of cancer. These children were relatively vulnerable because their diet was low in iodine. The oceans are the major source of iodine, and those who live far from the oceans may have iodine deprivation, which sometime results in enlarged thyroids, called goiters. The children's iodine-deprived thyroids avidly took up radioiodine. Of the 18 million children exposed, about 4,000 developed thyroid cancer and 15 have died. Fortunately, thyroid cancer can be treated with surgery, drugs, and radiation therapy very successfully. Ironically, many have been treated and cured with high doses of radioactive iodine!

            It's unlikely that this epidemic of thyroid cancer in children will recur as a result of the current tsunami-caused nuclear catastrophe in the Fukushima nuclear plants in Japan. These plants are on the seacoast, and seawater is rich in iodine. Therefore, the usual diet of this population is high in iodine. The thyroid uses a very small amount of iodine each day, and if children drink iodide solutions, supplied by the Japanese government, or eat seaweed, which has a lot of iodine in it, the thyroid uptake of radioiodine is reduced to very low amounts.

            Like so many aspects of modern life, radioactive iodine can be a blessing or a plague, depending on how it is used.

Saline for Elephants

            My connection with elephants goes back a long way—about five million years! In 1980 I used the technique, radioimmunoassay, to test molecules of the extinct mammoth and the two living elephant species. The protein albumin extracted from a 40,000 year old frozen Siberian mammoth named Dima was compared with the albumins of Indian and African elephants. The resulting molecular family tree, the first ever to include an extinct species, showed that the three pachyderms had diverged from a common ancestor about five million years ago.

            In my new novel, The Dark X: a Medical Mystery and African Adventure, Bamoba, a forest elephant, is a friend of Suzanne, a primatologist who grew up in the forest. Forest elephants are a smaller version of the giant African elephants usually seen on safari. Bamoba, incidentally, was named before Obama became a household word. Sara Gruen's popular novel, Water for Elephants, features a circus elephant of the Indian species.

            In the Central African Republic (CAR), forest elephants often gather and romp in geological features called saline pans, flat areas formerly covered by salt water, which has now mostly dried out, but ponds and marsh remain where elephants may bathe, roll in the mud and consume salt other minerals. Forest elephants are threatened by hunters and poachers. Though their tusks are smaller than those of their larger savanna kin, their ivory is denser and considered more desirable.

In The Dark X, an attack by poachers takes place in which Bamoba has a leading defensive role. Suzanne and Bamoba are determined to save the elephants, and a dramatic confrontation ensues.

Stories about Male Apes which Love Human Females

            My new novel, The Dark X: a Medical Mystery and African Adventure, features a wild chimpanzee which adores a female primatologist. The theme of an ape devoted to a human female goes back more than half a century to the original movie King Kong, about a fierce giant gorilla which falls for a young woman who fits into the palm of his hand as he climbs the Empire State Building and fights off the U.S. Air Force.

            The Evolution of Bruno Littlemore is a novel about a Chicago-Zoo-born chimp which not only falls in love with his trainer but becomes her lover. He learns the English language so well that he writes his own story of the affair.

            King Kong and Burno Littlemore are really humans in disguise. King Kong is more monstrous physically and behaviorally than any actual gorilla. Except when they or their families are threatened, wild male gorillas are rather gentle creatures. Bruno Littlemore reads books and acquires Shakespearean ways with words—quite an accomplishment for a brain one-third the size of ours. No actual chimpanzee has mastered more than several hundred words.

            Flights of fancy in which apes express human emotions in sophisticated English may be entertaining, but I find real ape behavior more fascinating. The young bonobo Jinji in my novel behaves like a bonobo, not like a man in an ape costume. Primatologist Suzanne Albrecht, and her doctor, Tony Miller, being human, must deal with their own emotions as well as Jinji's.

Are Southpaws More Likely to become President and Die Younger?

            I've been working with radioactive materials for most of my life, but according to an article in The New England Journal of Medicine some years ago, being left-handed is a much greater risk to my life and health than exposure to radiation. The two statisticians who wrote the article had examined death certificates in Southern California and found that the mean age of death for right-handed people was 75, for southpaws 66.

            Outraged responses poured in to the Journal. One writer called the authors' conclusions a classical fallacy. Using the same approach, they would conclude that nursery school is more dangerous than paratrooper training, since the mean age of death for nursery school children is much lower than that for paratrooper trainees. Left-handers on average are younger than right-handers, because the older generation was under more pressure to switch from left to right than the recent one. This accounts for the apparent nine year difference.

            When I was in training to become a nuclear physician, an article appeared in another medical journal, reporting that radiologists die at a younger age than other physicians, not only of cancer but of all causes. These frightening statistics confirmed the authors' suspicion that radiation accelerates aging. It turned out, though, to be the fallacy of the nursery school kids and paratroopers. Radiology is a newer specialty than general practice and surgery, so radiologists as a group are younger than GPs and surgeons, Corrected for age, the data showed no difference in mortality.

            An article in the New York Times Science Section, March 8, 2011, reminded me of these statistical brouhahas. Perri Klass, M.D. revisited the mysteries of why only about one out of ten of us are left (sinister, gauche), while the majority are right (straight, true, just, lawful, morally good, correct). Despite this linguistic and cultural bias, four out of the seven most recent presidents have been left-handed—Ford, the elder Bush, Clinton, and Obama. These statistics imply that a sinister clumsy wrong-pawed American is twelve times as likely to make president as a citizen who is just right.

            These kinds of confusions were once summed up by British prime-minister Benjamin Disraeli: "There are lies, damned lies, and statistics."

Women Who Study Apes

            Jane Goodall was the first and is still the best known of the ape ladies. She started observing chimpanzees at Gombe Stream, Tanzania, in 1960 under the tutelage of famous fossil-hunter Louis Leakey, who thought apes could tell us a lot about how our early ancestors behaved. Subsequently Leakey sent two other women into the field, Dian Fossey in 1967 to study gorillas In Rwanda and Biruté Galdikas in 1971 to be an orangutan-watcher in Borneo. These three women became known as Leakey's Angels, echoing the name Charlie's Angels, after a long-running TV show in which a man directs the investigational activities of three beautiful athletic women. Leakey was to have had a fourth angel to study bonobos, but the funding and permits hadn't been arranged when he died in 1972.

Suzanne Albrecht, the heroine of my novel The Dark X, studies bonobos, also known as pygmy chimpanzees, in Central Africa:

            My wife Adrienne Zihlman, who also knew Leakey, is sometimes called the ape lady of Santa Cruz because she has been studying ape anatomy for many years. She has a laboratory at the University of California, Santa Cruz, where she examines the bones and bodies of apes who have died of natural causes in the wild or in zoos. She has analyzed the bones of Flo, Flint and other chimps made famous by Jane Goodall.  Zoo personnel send her the bones or bodies of their dead animals, so they can still contribute to our knowledge of primate evolution.

            Because Adrienne is an anthropologist and I'm a doctor, many of my readers assume the two main characters in The Dark X, Suzanne and Tony, are modeled on the two us. Like most novelists, I've put some of myself and those I know into the characters. In our many trips to Africa, Adrienne and I have observed chimpanzees with Jane Goodall, Dian Fossey's mountain gorillas in Rwanda, lowland gorillas with Melissa Remis in the Central African Republic, baboons with Shirley Strum and patas monkeys with Dana Olson in Kenya. I've watched not only the primates but the fascinating women who spend years of their lives in wild Africa studying them.

As a doctor, researcher, teacher, and writer, I have, of course, ,known many other doctors. Adrienne is not Suzanne, though both love stylish clothes, and I'm not Tony, though we both like to sail. After I've written dozens of research papers and popular science articles, the fun of fiction is to weave a story out of my knowledge, experience, and imagination.

Doctors’ Dilemmas

Treat the Patient, not the CT Scan, advises Dr. Abraham Verghese in a recent op-ed piece in the New York Times. Verghese is a surgeon, a professor at Stanford Medical School and author of the best-seller, Cutting For Stone. Doctors have many dilemmas in treating patients, and a current one is keeping that treatment personal despite the plethora of diagnostic machines often needed for making a correct diagnosis.

            Verghese reminds us that the physical examination, the laying on of hands, is a fundamental bond between patient and physician. That bond is a vital part of the treatment, and it can be weakened or lost if mechanical procedures like CT or MRI scans seem to be replacing the personal doctor-patient relationship. On the other hand, the patient certainly wants the doctor to be knowledgeable about the latest advances in medicine and employ them when they’re indicated. There’s a fine balance between too much and too little testing.

            There’s also a fine balance in doctor-patient relationships between the personal and the intimate. The great physician William Osler emphasized the importance of bedside teaching, instead of sitting in a conference room and talking about the patients. My novel, The Dark X: a Medical Mystery and African Adventure, begins with two doctors on medical rounds engaged in bedside teaching for medical students, residents, and nurses. The two patients being examined and discussed are attractive young women. Since doctors, like patients, are human, at times they may be tempted to let the professional relationship become intimate.

             Medical ethics strictly forbids this, and a physician who violates this stricture risks the loss of his license to practice.  Hippocrates, the Greek physician who was the founder of modern Western medicine, required his students to take an oath that they would not use their medical role to seduce a patient. Various versions of this oath are still taken by many graduating medical students. But what if the patient, rather than the physician, wants to cross the line? The stricture still applies. Patients may feel they are in love with their doctors, but the doctor’s oath denies him the right to allow the professional relationship to become sexual.

            The patient, Suzanne, an “ape lady” with a strange disease, and her doctor Tony, spend a month in the jungle together, seeking to find the cause and cure for her potentially lethal malady. Along with dangerous animals and politics, their feelings for each other are a source of tension throughout the story.

Doctors' Dilemmas

Treat the Patient, not the CT Scan, advises Dr. Abraham Verghese in a recent op-ed piece in the New York Times. Verghese is a surgeon, a professor at Stanford Medical School and author of the best-seller, Cutting For Stone. Doctors have many dilemmas in treating patients, and a current one is keeping that treatment personal despite the plethora of diagnostic machines often needed for making a correct diagnosis.

            Verghese reminds us that the physical examination, the laying on of hands, is a fundamental bond between patient and physician. That bond is a vital part of the treatment, and it can be weakened or lost if mechanical procedures like CT or MRI scans seem to be replacing the personal doctor-patient relationship. On the other hand, the patient certainly wants the doctor to be knowledgeable about the latest advances in medicine and employ them when they're indicated. There's a fine balance between too much and too little testing.

            There's also a fine balance in doctor-patient relationships between the personal and the intimate. The great physician William Osler emphasized the importance of bedside teaching, instead of sitting in a conference room and talking about the patients. My novel, The Dark X: a Medical Mystery and African Adventure, begins with two doctors on medical rounds engaged in bedside teaching for medical students, residents, and nurses. The two patients being examined and discussed are attractive young women. Since doctors, like patients, are human, at times they may be tempted to let the professional relationship become intimate.

             Medical ethics strictly forbids this, and a physician who violates this stricture risks the loss of his license to practice.  Hippocrates, the Greek physician who was the founder of modern Western medicine, required his students to take an oath that they would not use their medical role to seduce a patient. Various versions of this oath are still taken by many graduating medical students. But what if the patient, rather than the physician, wants to cross the line? The stricture still applies. Patients may feel they are in love with their doctors, but the doctor's oath denies him the right to allow the professional relationship to become sexual.

            The patient, Suzanne, an "ape lady" with a strange disease, and her doctor Tony, spend a month in the jungle together, seeking to find the cause and cure for her potentially lethal malady. Along with dangerous animals and politics, their feelings for each other are a source of tension throughout the story.

Talking with Animals

            Two readers of my novel The Dark X told me that the least plausible scene is the one in which Suzanne, the "ape lady," talks to a hungry lion in its own language. Suzanne grew up in Africa with her missionary parents and often "adopted" young animals that had been orphaned by hunters. The lion was one she hadn't seen for years. She studies bonobos, a species of intelligent and sexy chimpanzees and has become an expert at animal-human communication. She is described by someone who has seen her in a National Geographic film as a triple-threat combination of Jane Goodall, Tarzan, and Dr. Dolittle.

            Her doctor and companion Tony is amazed by her ability to read his mind, when she is really reading the facial expressions that reveal his thoughts and emotions. Charles Darwin wrote a book,The Expression of Emotions in Man and Animals, in which he deduced that such expressions are hard-wired in the brain. My colleague Paul Ekman at the University of California, San Francisco, has carried this research much further and catalogued thousands of human facial expressions and what they mean. Suzanne is doing the same thing with bonobos, but she also likes to talk with other animals, including a friendly elephant. Research in recent years has shown how elephants communicate with each other in deep vocalizations that travel long distances through the earth. Monkeys make different sounds for different predators like snakes and eagles.

            Like us, chimpanzees, elephants and lions are social animals who deal with each other by vocalizations, facial expressions, and body language. The readers who doubted the plausibility of Suzanne's dialogue with a lion should view the true story, now on You-Tube, of two young Englishmen who adopted and cared for a lion cub until he was big enough to go into the wild. Years later they went to Africa, tracked him down, and someone filmed him coming at their call, standing up with his forelimbs on their shoulders, and licking their faces. We talk to our dogs, cats, and horses, and they, in their way, talk to us. It's not much of a stretch to imagine a devoted scientist who grew up in the jungle carrying on conversations with her fellow-animals.

A Love Letter to San Francisco

I fell in love with San Francisco when, as a sailor on my way to the South Pacific, I was billeted for five days at the Sir Francis Drake Hotel on Powell Street. Bells jingled under my window as cable cars toiled up the steep hill. Morning fog dissolved to reveal Victorian houses in bright clean pastel colors. Chinatown offered great restaurants and racks of exotic food along the sidewalks. From the hilltops, I could see the Golden Gate Bridge and the waters enfolding the beautiful city. The people were friendly and there were lots of pretty girls. I was too young to be admitted to Top O' the Mark, and I vowed I'd come back when I was old enough.

            A few years later I returned as an intern at Stanford University Hospital. An easterner born and bred, I thought I was coming for a year, but my enchantment with the place has kept me here for a medical career, evolutionary research, and scientific writing.  As I walk the streets of diverse neighborhoods, sail the bay, go to the opera, the museums, and the Golden Gate Park, San Francisco continues to be my private garden, my magic kingdom.

            My new novel, The Dark X: a Medical Mystery and African Adventure is also a love letter to San Francisco. The story unfolds with medical rounds at the University of California, San Francisco, a sail on the bay, a lecture on chimpanzees at a mansion on Telegraph Hill, a tryst in Noe Valley, a romantic confrontation at the Legion of Honor art museum, walks through Golden Gate Park and along Clement Street with its hundred or so restaurants.

One of my readers wrote that people coming to spend time in San Francisco should take my book as a guide!

Humans, Chimps, and Art

Humans are the only species that can replicate themselves artistically as well as sexually. Chimpanzees love to draw, but they are abstract expressionists rather than portrait painters. They can make colorful daubs in the mode of Jackson Pollock, but none has been able to draw the figure of another chimp or animal or plant. Cave art like the gorgeous paintings of bison, horses, and mammoths seen at Lascaux in France and Altamira in Spain seems to have burst out in modern human evolution about 50,000 years ago. Even our closest known relatives, the extinct Neanderthals, did not paint their cave walls.

Art appears to be a unique product of the brain of Homo sapiens. Its presence in the brain is further indicated by the remarkable fact that some patients with a condition known as frontotemporal dementia become excellent sophisticated painters, though they have no history of artistic talent or training.

One of the themes of my novel, The Dark X: a Medical Mystery and African Adventure, is human and animal communication. Art is an important way we have of communicating with each other, and two of the characters, the billionaire Bo Billingsley and Tony's ex-lover Julia Hatfield are also art collectors. There is a dramatic scene in which Julia, who studied art history at Stanford, challenges the authenticity of Bo's most expensive and precious painting. How this disagreement plays out is an important moment in the plot, which involves the intertwined relationships of five humans and one chimpanzee.