January 25, 2007

President George W. Bush
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500

Dear President Bush:

We are writing on behalf of the American Thyroid Association
(ATA) to request that you rectify a very significant deficit in a
particular aspect of antiterrorism preparation: namely, the lack of
availability of potassium iodide (KI) for protection of young people
against developing thyroid cancer in the event of a release of
radioactive iodine. The ATA is a professional society of over 900
endocrinologists, surgeons and nuclear medicine physicians and
researchers specializing in diseases of the thyroid gland. The ATA
promotes excellence and innovation in clinical care, research,
education, and public advocacy.

Section 127 of the 2002 Bioterrorism and Response Act directed you
to establish a program that would increase the availability of KI to
State and local governments for persons within 20 miles of a nuclear
power plant. In response, a 2004 study by the National Academy of
Sciences (NAS) recommended that “KI should be made available to
everyone at risk of significant health consequences from
accumulation of radioiodine in the thyroid in the event of a
radiological accident”. Draft guidelines were then prepared by the
DHHS, published in the Federal Register in August 2005, and
revised after considering comments from the public. We understand
that these revised guidelines have long been pending in the White
House Office of Management and Budget as a result of objections
raised by the Nuclear Regulatory Commission. Dr. William Kane
from the Nuclear Regulatory Commission writes in his November 1,
2005 letter to Dr. Claypool of DHSS that removal and isolation of
contaminated products is equal to or superior to KI protection of the
thyroid gland after radioactive iodine release. Although this
statement is supported by reference to the NAS report, our Public
Health Committee, including several members of the NAS panel,
believe that these statements are taken out of context. KI ingestion is
the only tested and proven approach to protect against thyroid
cancer.

The nuclear power station accident at Chernobyl in 1986 has made it perfectly clear that an accident or terrorist act at a power station in the USA could result in literally thousands of cases of thyroid cancer in children exposed to released radioiodines. The safety and effectiveness of KI in preventing these cancers is well established, especially the successful Polish experience with KI distribution after the Chernobyl accident. KI is not a panacea for all radiation effects, but it is an essential addition to other protective measures, namely sheltering, evacuation, and restriction of contaminated foods, to protect the thyroid against inhaled or ingested radioiodines.

The NAS report also states that it must be remembered that the plume phase and ingestion phase protection zones are established to provide a planning basis, and that a specific incident might call for protective actions to be implemented beyond the planning zone. Increasing the number and distribution of KI stockpiles is key to improved protection because KI must be given very quickly to be effective. Individually sealed KI tablets protected from light are long lasting. Although we have fortunately not yet had an accident that has required KI, it is irresponsible that this simple and inexpensive remedy has yet to be put in place to protect our young people.

We urge you to put an end to this unnecessary delay as soon as possible and institute the DHSS guidelines. We look forward to your response, and are prepared to offer our expertise in the evaluation and implementation of this policy.

Respectfully submitted,

David C. Cooper, MD	Gregory A Brent, MD
President, ATA	Secretary, ATA

President
David S. Cooper, M.D.
Baltimore, Maryland

Secretary
Gregory A. Brent, M.D.
Los Angeles, California

Treasurer
Charles H. Emerson, M.D.
Worcester, Massachusetts

President-Elect
Rebecca S. Bahn, M.D.
Rochester, Minnesota

Secretary-Elect
Richard T. Kloos, M.D.
Columbus, Ohio

Treasurer-Elect
David H. Sarne, M.D.
Chicago, Illinois

Directors
Ernest L. Mazzaferri, M.D. (2007)
Gainesville, Florida

Bryan R. Haugen, M.D. (2007)
Denver, Colorado

Sandra M. McLachlan, Ph.D. (2007)
Los Angeles, California

Gilbert H. Daniels, M.D. (2008)
Boston, Massachusetts

Steven I. Sherman, M.D. (2008)
Houston, Texas

Matthew D. Ringel, M.D. (2009)
Columbus, Ohio

Mary H. Samuels, M.D. (2009)
Portland, Oregon

Antonio C. Bianco, M.D., Ph.D. (2010)
Boston, Massachusetts

Alan L. Farwell, M.D. (2010)
Worcester, Massachusetts

Michael T. McDermott, M.D. (2010)
Aurora, Colorado

Executive Director
Barbara R. Smith, CAE

Headquarters Office
American Thyroid Association
6066 Leesburg Pike, Suite 550
Falls Church, Virginia 22041