Feature

The Missing Element

Why an aging Canadian nuclear reactor could keep U.S. patients from getting the care they need.

Every day, U.S. doctors perform more than 50,000 state-of-the-art procedures using a radioactive isotope called technetium-99. Injecting technetium into a patient allows doctors to monitor the blood supply to the heart, look at cardiac function in chemotherapy patients, see whether certain cancers have spread to a patient's bones, or monitor a tumor during breast cancer surgery.

Most patients take for granted their ability to undergo these procedures. But they might be surprised to learn that nuclear medicine in the United States is dependent on one 52-year-old, leak-prone nuclear reactor that is currently offline, should have been shut down for safety reasons a decade ago, and moreover, undermines international nuclear nonproliferation goals.

How did we get into this predicament? In short: Blame Canada.

The National Research Universal (NRU) reactor in Chalk River, Ontario, supplies about one-third of the world's supply and about half of the U.S. supply of the molybdenum isotope that decays to form technetium. The reactor, built in 1957, is operated by the government-owned company Atomic Energy of Canada Limited. The reactor was first shut down for safety only a year after it opened, when a nuclear fuel rod caught fire, and it has suffered sporadic accidents and outages ever since. In 2007, after the reactor was shut down for a safety upgrade, the Canadian government, due to fears of an isotope shortage, ordered it open again over the objections of the Canadian Nuclear Safety Commission.

Canada's Natural Resources Ministry, which oversees the nuclear power industry, never intended for the NRU reactor to still be operating. Construction of two new reactors, known as MAPLE 1 and 2, began in 1996 after it became clear the NRU reactor was nearing the end of its useful life. The MAPLES were supposed to have become operational in 2000, but after numerous construction delays and unresolved safety issues and hundreds of millions of dollars spent, they were finally scuttled by Prime Minister Stephen Harper's government in 2006.

So the NRU reactor was left to sputter on alone, without backup. This May, the inevitable happened: A leak of radioactive water was detected at the facility, and it was again shut down.

The government's handling of the isotope debacle has been a front-page political story in Canada, particularly after Natural Resources Minister Lisa Raitt was caught on tape describing it as a "sexy" issue that she wanted to resolve to further her political career. Raitt later issued a tearful public apology to cancer patients.

Because disruptions to medical care have been minor in the United States so far, the issue hasn't garnered much attention below the border. But that could change in March. Since the NRU reactor went down, a Dutch reactor in Petten has been picking up the technetium slack, along with smaller reactors in Belgium, France, and South Africa. But starting in late March, Petten, itself a 48-year-old dinosaur plagued by technical glitches, will be off-line for scheduled maintenance.

The Canadian Natural Resources Ministry expects the NRU reactor "will return to service in the first quarter of 2010," according to spokesperson Micheline Joanisse. But that date has already been pushed back several times. And even if the reactor does go back online in 2010, it's unclear how much longer it can stay operational. The University of Texas at Austin's Alan Kuperman, a former senior policy analyst for the Nuclear Control Institute, notes the fragility of the situation. "Even if the Canadian reactor comes back online, we're only going to be one blip from a major supply crisis," he says.

This would be a serious blow to hospitals and cancer patients in the United States and abroad. "If the Canadian reactor isn't up and running, we're going to really be struggling come April," says Robert Atcher, director of the National Isotope Data Center and former president of the Society of Nuclear Medicine, who thinks that current technetium supplies are enough for only about two-thirds of global demand. Depending on how long the United States goes without a reliable supply of technetium, the effect could be anything from a minor irritation to a major catastrophe. In Canadian hospitals, which were almost entirely dependent on domestic technetium supplies and are already feeling the pinch, some nuclear-medicine practitioners report canceling the majority of their diagnostics, and tests for heart damage and the spread of cancers have been delayed for weeks, with untold financial and health costs.

Giuseppe Esposito, director of nuclear medicine at Georgetown University Hospital, says that his department hasn't felt the effects of the shortage yet, but that a more permanent disruption would make many of his regular procedures impossible to carry out. "For lung and bone imaging, there really are no substitutes [to technetium]," he says.

You might think that, given the relatively small number of suppliers, the United States, which accounts for about 50 percent of global demand for technetium, would have wanted to develop its own supply. And indeed, there were plans to build a reactor for medical use in New Mexico in the mid-1990s. But the project was abandoned after Canadian authorities made what Atcher describes as a "compelling case" that the ill-fated MAPLE facility would meet international demand.

Joanisse denies that the Canadian government misrepresented the state's production capabilities to its customers. "All along, our message to the international community has been simple," she said via e-mail. "We rely on ageing reactors and a fragile supply chain. There is a collective responsibility to bring forward additional sources of supply and to manage available supplies responsibly, particularly in periods of shortage."

But given the costs of building a nuclear reactor, governments, including the U.S. government, were all too happy to let Canada shoulder the burden. "No one wants to spend the money and political capital to build a new reactor these days," says Edwin Lyman, senior scientist at the Union of Concerned Scientists' global security program. "Everyone put their eggs in the Canadian basket."

Faced with the possibility of a technetium shortage within coming years or even months, the U.S. government is finally taking action. A bill passed in the House of Representatives and under consideration in the Senate would allocate $163 million to investigate new methods for producing medical isotopes. Although this money probably isn't enough to build even a single reactor, it's the first step the United States has taken in years to developing isotope independence. A research reactor in Missouri is also being converted to produce isotopes, though Lyman notes that even under the best conditions, "there won't be a stable substitute ... for at least three years."

Most importantly, the proposed legislation would also specify how medical isotopes are made. Both the Canadian and Dutch reactors produce technetium from bomb-grade highly enriched uranium, a situation that keeps nonproliferation experts up at night.

"The Canadian government always gets up and says, 'We're a leader on nonproliferation,'" U.T. Austin's Kuperman says. "But they're also the country in the world using the largest amount of bomb-grade uranium for civilian purposes. You can't have it both ways."

Under the proposed legislation, all suppliers to the U.S. market would be required to use safer, though slightly more expensive, low-enriched uranium. An expert panel convened by Canada's Natural Resource Ministry recommended last week that the country switch entirely to low-enriched uranium, though in the short term highly-enriched will continue to be used at the NRU reactor.

In any event, Canada's days as a leader in medical isotopes seem to be over. The Natural Resource Ministry's panel recommended the construction of a brand-new multipurpose research reactor, though given the emergency measures that other countries are taking -- the Netherlands and Australia are also looking to boost their production capacity -- it's not clear that there will still be a market by the time it is completed.

In June, Harper said, "Eventually, we anticipate Canada will be out of the business" of producing medical isotopes -- a realization that patients around the world might have wished for a decade ago.

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Feature

America's IED Nightmare

It's a problem that was supposed to be solved by now. But these deadly little devices are only growing more lethal as the costs of combating them mounts.

On one side, the U.S. Department of Defense, armed with billion-dollar budgets, state-of-the-art technological savvy, and the world's most formidable military machine. On the other, tiny groups of fly-by-night guerillas hunkered down in hideouts scattered around the world, scavenging remote-control toys or old artillery shells, soldering wires in ruined buildings or sneaking out to plant fertilizer bombs on moonlit desert roads. You'd think that the second bunch wouldn't stand a chance. In fact, though, the makers of improvised explosive devices (IEDs) are more than holding their own -- still -- at the cost of thousands of lives among the Americans and their allies around the world.

Though the story didn't get much attention from the media at large, last month U.S. Secretary of Defense Robert Gates effectively acknowledged that the Pentagon has yet to gain the upper hand in the battle against makeshift bombs. Some 80 percent of the casualties suffered by U.S troops and their allies in Afghanistan are now attributable to IEDs. By now, that once-obscure military term has presumably become a commonplace to anyone who's been following the news. Ever since the U.S. and its friends invaded Iraq in the spring of 2003 the homemade bomb has become the weapon of choice for insurgents around the world: not just in Iraq and Afghanistan, but also on battlefields from the Horn of Africa to Southeast Asia. Two Navy SeaBees (military engineers) were killed by an IED in the Philippines at the end of September. They were the first U.S. casualties in that country since 2002. (U.S. defense officials say that some 300 IED incidents are now occurring each month outside of Iraq and Afghanistan.)

The Pentagon certainly hasn't been sleeping. The U.S. military has repeatedly declared neutralizing the IED threat to be a top priority. Since 2003 the Department of Defense (DOD) has thrown some $20 billion at the problem, setting off a gusher of gadgets, training programs, and acronym-studded bureaucratic bailiwicks. Now Gates has pressed the restart button. Last month, he announced that he was creating a new military task force, to be headed by two Pentagon heavyweights, "to break down the stovepipes" that have kept the various anti-IED efforts across the national-security bureaucracy from cooperating more effectively.

His decision came soon after the Government Accountability Office (GAO) issued a scathing report on the Pentagon's inefficient and ineffective efforts through a bureaucratic jungle of agencies, working groups, and initiatives. Among other things, the report criticized the lead DOD agency on the problem, the Joint IED Defeat Organization (JIEDDO), for failing to maintain a database keeping track of the many efforts now tackling the problem throughout the vast American military bureaucracy -- which would presumably help reduce unnecessary overlap and waste.

That's not to say that JIEDDO and its various affiliates haven't already accomplished a lot. Since JIEDDO was founded back in 2006, it has devised a wide variety of special jammers to block the remote-control signals used by insurgents to set off buried bombs. It has come up with advanced ground-penetrating radars that can tell operators if there's anything suspicious under an unpaved road. It has promoted the development of sophisticated bomb-disposal and detection robots. And -- even more usefully -- JIEDDO has also developed new intelligence-gathering systems for thwarting bomb-making networks and retraining troops on how to deal with the threat in the field. Ex-JIEDDO chief General Montgomery Meigs, now a professor at Georgetown University's Center for Security Studies, boasts that the U.S. military succeeded in reducing the casualty-to-blast ratio of IEDs in Iraq and Afghanistan during his tenure. In 2002, he says, each bomb explosion caused, on average, six casualties (wounded and killed). By the end of 2007, when he left the position, that figure was down to one.

And yet troops continue to die from bomb attacks in Afghanistan at a fearsome rate. Though the Taliban and their allies were comparatively slow to discover the advantages of using IEDs, over the past two years they've turned roadside bombs into their primary weapon. Countering that threat in Afghanistan is proving even more of a challenge than it was in Iraq. Dakota Wood and Andrew Krepinevich of the Center for Strategic and Budgetary Assessments in Washington points out the makeshift bombs being used against U.S. troops in Afghanistan pose a whole new set of challenges. Iraq, they note, is a "relatively modernized 20th-century country" with paved roads, a fact that often makes it easier to figure out where bombs might be planted. Iraqi bomb-makers made ample use of explosives looted from countless Saddam-era munitions dumps scattered around the country -- which tended to translate into myriad but comparatively small-scale attacks. (A Congressional Research Service report on the IED problem a few years ago noted that 40 percent of Saddam-era munitions still weren't being properly guarded a full year after the invasion.) By contrast, Afghanistan has almost no modern infrastructure; the relatively small number of troops there isn't enough to cover its much larger territory. And paved roads are virtually nonexistent, making it easier for Afghan insurgents to hide their explosive packages.

In Iraq, the insurgents proved adept at crafting found munitions -- everything from hand grenades to 155-mm howitzer shells -- into explosive booby traps. In Afghanistan, the preferred IED has been the fertilizer bomb. Even thought the number of "IED incidents" has been lower in Afghanistan, the Taliban have kept casualties high by making their bombs much bigger. The U.S. and NATO forces have responded with everything from high-tech electronic countermeasures (to block command signals) to intense drone surveillance of spots where IED activity tends to be highest. In some parts of the country American troops have even taken to seizing or buying up fertilizer from farmers -- the same farmers who, presumably, have been lectured on the need to replace low-maintenance opium poppies with proper, fertilizer-intensive crops.

The biggest problem for IED-fighters, though, is simply that the target is constantly on the move. The bomb-makers have proven remarkably deft at upping the explosive ante. "There's one thing the more candid generals will tell you," says John Bennett, a reporter with U.S. defense weekly Defense News. "I think they've been caught off guard a bit by how smart the enemy is, how inventive they are."

"The enemy isn't very helpful," admits Meigs. "He keeps adapting every six months." The first Iraqi IEDs were primitive affairs that didn't always explode like they were supposed to. But by October 2003 the insurgents had gained enough know-how to blow up an M1A2 Abrams tank, killing two of its crewmen. U.S. military planners are clearly worried that worse may be in store for their troops in Afghanistan as the Taliban hone their engineering skills.

That speed of adaptation makes it even harder for cumbersome bureaucracies to cope. The GAO report listed a bewildering mélange of competing or overlapping agencies assigned to deal with the IED threat. That proliferation is, in part, the somewhat understandable consequence of the way U.S. military planners reacted to the IED problem. As the casualty figures rose, both defense bureaucrats and congressional policymakers began urging immediate attention to the problem -- and providing corresponding amounts of money to get it fixed.

According to Bennett, the Defense News journalist, "Gates is big on reducing redundancy, and he knows that, if you have a Marine program and an Army program that are doing the same things, it makes sense to free up smart people to do other counter-IED systems." In retrospect, Bennett says, it looks as though JIEDDO wasn't provided with the "proper bureaucratic muscle" to accomplish its mission. The two men appointed by Gates to head the new task force are Marine Corps Lt. General John Paxton, the Joint Staff's director for operations, as well as Pentagon acquisition chief Ashton Carter -- both figures of the required institutional heft.

"What Gates is doing here shows why he's a master bureaucrat," says Bennett. "If these guys tell you to merge your efforts, chances are you're gonna do it." Gates has shown similar determination in his high-pressure initiative to design, build, and field a new generation of Mine Resistant Ambush Protected (MRAP) vehicles. By essentially bypassing normal bureaucratic channels, the multibillion-dollar program has succeeded in getting 15,000 of the new vehicles to troops on the battlefield in just two years -- lightning speed by Pentagon standards.

Still, no one believes that Gates or his colleagues will be able to solve the problem for good. It's important to remember that the idea of "waging war on the IED" is a metaphor. Ultimately, notes ex-Marine Wood, you can't hope to eradicate the threat from IEDs any more than you can the threat from bullets. He warns that the effort to protect soldiers and prevent casualties, while urgently needed, can sometimes lose sight of other vital criteria. "We place a tremendous value on human life and the prevention casualties," he says. "But there are costs to that, too. You can take a $500 artillery round and our response has been a million-dollar MRAP." While the "MRAP surge" has succeeded in equipping troops with the much-needed vehicles, the sheer speed of the effort inevitably has brought problems of its own, such as lack of spare parts or adequate maintenance programs. The services now find themselves saddled with a hodge-podge of vehicles from different manufacturers. And then there's the longer-term issue of what to do with the new MRAP fleet once U.S. troops withdraw from the places they're fighting in now.

What's more, experts say, keeping troops penned up in ponderous, heavily armored vehicles may keep them safe even while undermining the mission they're trying to achieve. Current U.S. counterinsurgency doctrine demands that troops spend as much time as possible outside of their vehicles, mingling with the local population to build trust and gain information, rather than patrolling the countryside encased in armor. The weighty MRAPs also guzzle far more fuel than previous vehicles, Wood points out, which in turn entails ever-larger supply convoys to serve them -- convoys that then make wonderful targets for the bombers.

But then, of course, tech isn't the answer to everything. As all those involved in the counter-IED effort readily acknowledge, beating the bombs isn't just a matter of coming up with clever gadgets. It's also about developing slippery human skills of perception and intuition. One recent JIEDDO study tried to figure out which troops were best at detecting concealed IEDs in test landscapes. Two groups scored especially well: those who had grown up hunting, and those who had grown up in crime-ridden inner cities. The reason is that the members of both groups have a knack for paying close attention to their surroundings. The test subjects who had spent their formative years glued to video screens couldn't compete. Food for thought?

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