I have just published a commentary on the catch phrase " Too cheap to meter" which has been continuously used by anti nuclear activists to show nuclear power in poor light. I found that most of  such critics used it prolifically in their articles. These and other details you can  read in the article which has been published in "The Daily Star" on April 26, 2012.

This article can be accessed at:

 http://www.thedailystar.net/newDesign/news-details.php?nid=231626

 

The Daily Star

Thursday, April 26, 2012

OP-ED

Will nuclear power ever be too cheap to meter?

K.S. Parthasarathy

Is there an easy method to identify whether the author of an article on nuclear power is antinuclear or not? Look for the well known catch phrase "too cheap to meter" in the article. If you find it, the writer is most likely anti-nuclear!
According to Wikipedia, " 'too cheap to meter' describes a concept in which a commodity is so inexpensive that it is more cost-effective and less bureaucratic to simply provide it for a flat fee, or even free, and make a profit from associated services."
Did any prominent pro-nuclear advocate ever promise that nuclear power will one day be too cheap to meter? If he did, the idea is too good not to be referred to! Since it is an impossible objective, anti-nuclear critics can convincingly argue that nuclear power has failed to deliver on its promise. This taunt is very effective in demoralising the pro-nukes.
Who gave this unattainable promise on nuclear power? Or was it an attribution made totally out of context?
Nuclear energy began with very high hopes. Walter Marshall, one of its pioneers in the United Kingdom, told Britons it would provide energy "too cheap to meter." It was going to usher in an era of abundant, clean power, and an end to the filth and smoke of coal-fired power plants, Alex Kirby, BBC environment correspondent, wrongly attributed the phrase to Walter Marshall, former Chairman, Central Electricity Generating Board, (BBC News, June 15, 2000).
There is convincing evidence that Lewis Strauss, Chairman of the US Atomic Energy Commission, while addressing the National Association of Science Writers, made the relevant statement on September 16, 1954
He stated thus: "Our children will enjoy in their homes electrical energy too cheap to meter," he declared. "It is not too much to expect that our children will know of great periodic regional famines in the world only as matters of history, will travel effortlessly over the seas and under them and through the air with a minimum of danger and at great speeds, and will experience a lifespan far longer than ours, as disease yields and man comes to understand what causes him to age" (The New York Times, September 17, 1954).
A Google search, with "Walter Marshall" and "too cheap to meter" as keywords, gave 681 references. When the search was repeated, with "Lewis Strauss" in place of "Walter Marshall," I got 81,100 references. These numbers change slightly, but their order is the same. Surely Strauss is the winner! The quote can be attributed to him
Ramachandra Guha, a well known Indian historian, cast his net far and wide when he wrote: "Back in the 1950s, when nuclear energy was all the rage and scientists the world over were claiming that it would soon be 'too cheap to meter'…." (Anthropologists among the Marxists and other Essays). In this instance, he was less than accurate!
"It has been repeatedly inflicted on the public, because it's cute, catchy and empty of substance," Morgan Brown, Atomic Energy Canada Limited, wrote about the catch phrase in RADSAFE news group. He compiled a number of quotes from the time period before and after Strauss' speech; none indicated anything but a rational technical approach to the economics of nuclear power. Morgan's review provided abundant evidence that few people in the industry at the end of 1950s really believed that nuclear power would be very cheap.
Strauss did not refer to nuclear energy in his speech. Some argued that he was talking about energy from fusion rather than fission. Strauss knew about Project Sherwood, the USA's secret programme on controlled nuclear fusion.
Chris Anderson of WIRED BLOG network did his own research on the origin of the "too cheap to meter" phrase. He also thought that Strauss was talking about "fusion" because Strauss knew that fission would probably be more expensive than coal.
Anderson clarified that "too cheap to meter" didn't mean free -- it just meant too cheap to monitor closely. He noted that some buildings built around that time, including the World Trade Center, were designed without light switches in each office; the building managers could just turn whole floors on and off , like a Christmas tree.
Is there anything too cheap to meter? "Today, we have three technologies -- processing power, digital storage capacity and bandwidth -- that touch nearly as much of the economy as electricity, and they really are becoming too cheap to meter," Anderson added.
Nicholas Carr of roughtype.com says that Amazon's S3 storage waived monthly charges for backing-up the hard drive of a software engineer; the bill was for $ 0.01. The credit card company refused to process the bill!
Google searches with the names of well known antinuclear critics, Praful Bidwai, M.V.Ramana, Rosalie Bertell, Arnie Gundersen and Arjun Makhijani, with the phrase "too cheap to meter" for each, registered 804, 2,240, 1,410, 3,630 and 44,700 references respectively. It indicates how prolifically they benefited from using this catch phrase in their articles!
Anti nuclear activists mostly use "too cheap to meter" out of context. Nuclear power is unlikely to become too cheap to meter.

The writer is a former Secretary, Atomic Energy Regulatory Board, India.

E-mail: ksparth@yahoo.co.uk

Lung cancer: CT screening only for heavy smokers

S & T

April 25, 2012 

 Lung cancer: CT screening only for heavy smokers

The Hindu CAUTION ADVISED: Low-dose CT screening produces large false-positive results. Photo: K.R. Deepak 

Low dose CT screening for lung cancer is recommended only for 55-74-year-olds who have smoked a pack daily for 30 years
 

On April 23, 2012, the American Lung Association (ALA) released its interim guidance recommending low dose computed tomography (CT) screening for diagnosing lung cancer among smokers. The recommendation is based on the first report of the ALA lung cancer screening committee, chaired by Dr. Jonathen Samet from the University of Southern California.

The recommendation

ALA recommends screening only for a limited group. These are current or former smokers, aged 55 to 74 years with a smoking history of at least 30 pack-years and no history of lung cancer.

Smoking history of 30 pack years means smoking a pack of cigarettes daily for thirty years or two packs daily for 15 years etc.

ALA notes that while CT screening for lung cancer may save lives, it should not be recommended for everyone due to many known and unknown risks that may be associated with the screening and subsequent medical evaluation and follow-up. Radiation risk is one of them.

In spite of this caution, Auntminnie.com, a trade journal, stated that the move is a major step toward the development of a population-based CT screening programme in the U.S.

The U.S. National Cancer Institute's National Lung Screening Trial (NLST), found that low-dose CT can reduce mortality by at least 20 percent compared to chest x-ray, and other reports have pushed the estimated mortality gains even higher. The ALA guidelines followed the results of NLST of smokers at-risk, released in November 2010.

Even in this high risk group, 320 persons had to be screened with CT to prevent one lung cancer death.

The benefit of CT screening for lung cancer cannot be easily estimated for populations with risk profiles that are different from those of the NLST participants.

Can cause cancer

According to Centers for Disease Control and Prevention, screening with CT scans is not risk-free. Radiation exposure from repeated CT scans is cumulative and can lead to cancer.

Average effective radiation dose in “low dose” CT in NLST was 1.5 mSv as against 7 mSv in a full diagnostic helical CT.

Specialists have criticised low-dose CT screening due to the large number (as high as 25 per cent) of false-positive results, meaning that the positive finding did not prove to be lung cancer following diagnostic investigations. People who receive false-positive results may be subjected to unnecessary testing, including more radiation exposure, invasive diagnostic and surgical procedures, complications, and even death, diminishing the benefit of early cancer detection.

Over-diagnosis due to screening must have revealed indolent cancers which may never progress into full blown cancer. They may end up undergoing an invasive intervention that they would not otherwise need.

According to ALA, individuals should not receive a chest X-ray for lung cancer screening as it has low sensitivity.

ALA Committee suggested that ALA should ask hospitals and screening centres to: establish ethical policies for advertising and promoting lung cancer CT screening services; develop educational materials to assist patients in having careful and thoughtful discussions between patients and their physicians regarding lung cancer screening and to provide lung cancer screening services with access to multidisciplinary teams that can deliver the needed follow-up for evaluation of nodules.

Smoking, major cause

Lung cancer is a fatal disease. Currently, specialists believe that smoking causes up to 80-90 per cent of lung cancer cases.

The significance of the guidance is evident as the five-year survival rate for lung cancer presently stands at 15.6 percent as compared to an over 90 percent survival rate for breast, colon and prostate cancers.

ALA recommendation may lead to many undesirable developments. Hospitals may start direct-to-consumer advertising to recruit patients who might have resources to pay out-of pocket for low-dose CT screening.. “…the promotion of such services should not prey upon the public's fear of lung cancer while leading them to believe that low-dose CT screening will eliminate all risk from lung cancer,” ALA warned.

“Unfortunately, even before the NLST results were released, CT screening for lung cancer was being offered by some institutions and subsequent to the release an increasing number of well-respected medical centres throughout the country are offering lung cancer screening to their constituents at markedly reduced prices.” ALA observed.

Public cautioned

“Never starting smoking and quitting smoking still remains the best way to prevent lung cancer”, Dr Norman H. Edelman, Chief Medical Officer, American Lung Association cautioned the public.

Individuals have to take their own decisions on screening based on inputs from all

reputable sources. Do not trust advertisements glorifying CT screening.

K.S. PARTHASARATHY , Former Secretary, Atomic Energy Regulatory Board

(ksparth@yahoo.co.uk)  Keywords: computed tomography, lung cancer screening

Nuclear renaissance may continue

Nuclear renaissance may continue

Travails of medical imaging of bulky patients

Travails in medical imaging of bulky patients

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The constraint: Some obese patients are too large to image using even X-ray films of large size. They need multiple cassettes. Photo: AFP

Keen observation and analysis of case sheets of patients proved rewarding for Dr Raul Uppot, a young radiologist at the Massachusetts General Hospital (MGH), in Boston, U.S. He realised that a tiny fraction of patients are denied medical imaging facilities simply because they are bulky. Radiologists could not provide optimum image quality and accurate diagnoses in their cases.

Dr. Uppot and his co-workers reviewed the radiology reports filed between 1989 and 2003 labelled as “limited by body habitus” meaning limited in quality due to the patient's size. They found that over the 15-year period, the percentage of such reports nearly doubled from 0.10 in 1989 to 0.19 in 2003. It correlated strongly with the increase in obesity in Massachusetts State from 9 per cent in 1991 to 16 per cent in 2001.

He presented the study at the annual meeting of the Radiological Society of North America (RSNA-2004). RSNA appreciated his paper and awarded him the 2004 Research Fellow Trainee Prize of $ 1,000.

Dr Uppot observed that in the 15-year-old retrospective study of radiological exams at MGH, the diagnostic information of 0.15 per cent of the five million studies was limited by the body weight of patients. They did not include patients whose examinations were cancelled because they could not fit on the table.

Obesity adversely impacts on simple x-ray and other life saving procedures such as CT scans, ultrasound and magnetic resonance imaging (MRI).

The issue was so important that the RSNA held a special focus session on “Obesity: The Impact on Radiology” during its Annual convention (RSNA 2005) at Chicago. It continues to be important.

In a recent review in Vascular Medicine (December 2011) Philip C. Hawley of the Grant Medical Centre, Columbus and Miles P. Hawley, The Ohio State University Medical Center, Columbus, recommended further research on both imaging and outcomes in the area.

In Radiology Rounds, a newsletter for Referring Physicians, published by Massachusetts General Hospital, Janet Cochrane Miller noted that fat affects ultrasound images to a greater degree than any other medical imaging modality. At the frequency range normally used (3 to 7 MHz) for abdominal imaging, one cm of fat attenuates 50 per cent of the beam intensity. At lower frequencies attenuation is less; image resolution is also less.

Miller estimated that 20 patients in 1,000 may not get the benefit of ultrasound scans because of excess body weight. Corresponding data for MRI scan is one in 1,000; abdominal CT: 4 in 1,000; chest x-ray: 5 in 1,000.

Some obese patients are too large to image using even x-ray films of large size. They need multiple cassettes. “When they exceed the weight limit for x-ray tables, patients can sometimes be imaged while standing”, Miller wrote.

To a question whether he expects that the issues he raised in the U.S. will be applicable to India, Dr Uppot who is currently assistant professor, Harvard Medical School, clarified that the issues start with ultrasound imaging at 250 pounds.

“Census data in India may need to identify the percentage of Indians who reach more than 250 pounds”, he added.

Relevance to India

“Has he got any suggestions for the Indian medical community? “The Indian medical community should be aware of the issue. In India, as in other Asian and European countries there is great reliance of ultrasound for medical imaging.

Of all the imaging modalities, ultrasound is the most sensitive to obesity. Indians who have excessive subcutaneous fat will present challenges to physicians who rely on ultrasound to make diagnosis”.

To the query on improvements in producing optimal images of obese patients, Dr Uppot stated that “manufacturers of imaging equipment have tried to address the issue by: (1) Increasing weight limits and gantry/bore diameters of their equipment so that patients can fit. (2) Used technology to improve the image quality such as harmonic imaging for ultrasound and (3) and used technology to try to decrease the increased radiation doses for CT in obese patients”.

The Lancet (November 20, 2010) reported that currently in India, almost 1 in 5 men and over 1 in 6 women are overweight. In some urban areas, the rates are as high as 40 per cent. But I do not know of any Indian publication on the difficulties of imaging obese patients.

The medical community in India must appreciate the issues and be prepared to face the challenges of imaging overweight patients

K.S. PARTHASARATHY

Raja Ramanana fellow, Department of Atomic Energy

(ksparth@yahoo.co.uk)

Keywords: medical imaging, bulky patients

Why nuclear power is not the dream that failed?

On March 10, 2012, The Economist magazine published an article titled " Nuclear power: the dream that failed". The article was one sided and ignored many developments which may prove to be a game changer. For instance, Republic of Korea entered into a contract with UAE to construct four nuclear power reactors in UAE. Some specialists observed that Korea may complete the project on time and within budget, Korea has beaten French industry which is currently recalibrating its approach to commercial nuclear power. 

 You can access the article at:
http://www.rediff.com/news/slide-show/slide-show-1-why-nuclear-power-is-not-the-dream-that-failed/20120321.htm