A Medical Device Daily

A government advisory panel has concluded that the U.S. should replace more than 1,000 irradiation machines used in hospitals and research facilities because terrorists could use the radioactive materials inside them to make “dirty” bombs.

“Any one of these 1,000-plus sources could shut down 25 square kilometers, anywhere in the United States, for 40-plus years,” according to the Defense Science Board, a panel of retired military and CIA officials and defense industry experts.

The machines are in relatively unprotected locations such as hospitals and research facilities all over the country, and they may be tempting sources of radioactive materials for terrorists who want to make bombs that can disperse radioactive debris over large areas, rendering them uninhabitable, the board says.

The irradiators contain cesium-137, one of the most dangerous and long-lasting radioactive materials. They are used for radiation therapy and to sterilize blood and food.

Replacing the cesium irradiators with X-ray machines or irradiators that use other materials would cost about $200 million over five years, but it would take the most accessible sources of dangerous radioactive material inside the United States “off the table” for terrorists, the panel says.

The recommendation is part of an as-yet-unreleased Defense Science Board report that describes how unfriendly nations or terrorist groups could attack the U.S. with radiological or biological weapons or blackmail the U.S. government with a threat of a nuclear detonation, all while manipulating world opinion against the country in the news media and on the Internet.

The board’s report is expected to be released late this year.

Evidence lacking in osteoarthritis treatments

A new scientific review released by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) concludes that evidence of benefit is lacking for many common ways of treating osteoarthritis of the knee, including popular dietary supplement ingredients, a common surgical procedure, and injected preparations.

The review found that glucosamine and chondroitin, over-the-counter dietary supplement ingredients that are used widely because of their purported benefits to relieve knee pain caused by osteoarthritis and improve physical functioning, appear to be no more effective than placebos. A placebo is a harmless substance given to selected patients in a clinical trial that looks like the real drug or injection being studied, but which has no medical effect.

The review, which was requested and funded by HHS’ Centers for Disease Control and Prevention, also failed to find convincing evidence of benefit from arthroscopic surgery to clean the knee joint with or without removal of debris and loose cartilage.

Published studies generally report that injections with hyaluronan preparations (substances that are intended to improve lubrication of the knee joint) improve scores on patient questionnaires used to measure pain and function. However, the evidence is uncertain because of variation in study quality and difficulty determining whether changes in scores translate into real clinical improvements for patients.

“Millions of Americans seek relief from the pain and reduced mobility caused by osteoarthritis of the knee,” said AHRQ Director Carolyn Clancy, MD. “However, they should work with their clinicians to decide the best course of treatment for them based on what has and has not been proven to work.”

Osteoarthritis is a widespread, costly disease that wears away the cartilage cushioning the knee joint, causing pain and reducing mobility. Arthritic diseases, which include osteoarthritis, affect an estimated 46 million people in the United States, and at age 64 and older, one in 10 Americans is estimated to have osteoarthritis of the knee. Osteoarthritis and related arthritic conditions cost more than $81 billion a year in medical care, lost wages, and other expenses.

The review scrutinized individual studies concerned with these treatments’ effects as well as meta-analyses that analyzed the combined evidence of groups of studies.

According to authors of the review, better quality randomized clinical trials are needed to clarify whether these treatments are beneficial.