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The New York Times moly-99 report: 6 takeaways

by Thomas Dworetzky, Contributing Reporter | January 16, 2018
Molecular Imaging SPECT
The ongoing saga of securing a reliable U.S. source of moly-99 hit the mainstream Friday, when the New York Times took an in-depth look at the subject.

Here are the most important six points made in the story.

Of radioisotopes and ice cream cones
The present global supply chain for moly-99 is threatened by random “skittish” events – such as missed flights, baboons breaking into reactor facilities in South Africa, and weather that grounds shipments halfway around the world. “It’s like running through the desert with an ice cream cone,” Ira N. Goldman, senior director of global strategic supply at Lantheus Medical Imaging in North Billerica, Mass., tells the paper of record.

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A chance to SHINE in Paul Ryan's hometown
These vagaries in the chain, combined with potential real threats from terrorists looking for radioactive material, drove President Obama to sign off on 2013 legislation to promote U.S.-based moly-99 manufacturing. That ultimately led to development of the $100 million Shine Medical Technology Janesville, Wisconsin, plant – in Rep. Paul Ryan's hometown, and with $25 million of federal funds. Shine's founder Greg Piefer told the paper, “Ryan called me out of the blue and he said, ‘We really want you here.’” The plant has missed construction and budget targets, and is still seeking more money to finish.

The reality of going without
Many things could go wrong with the supply chain – including that it depends on reactors built during the Eisenhower era. They get shut down for maintenance and emergencies, which could lead to a break in the supply of generators. “We’ve had days when no generator comes in at all, or it’s been cut in half,” Andrew Paulsen, supervisor of the Mayo Clinic’s radiopharmaceutical laboratory told the Times.

The worldwide supply's vulnerability was highlighted in 2009-2010 when a pair of reactors had unscheduled closures. The ensuing shortage forced doctors to adjust. “For cardiac imaging, we had to shift to a more expensive agent and expose patients to more radiation,” advised Dr. Andrei Iagaru, chief of the division of nuclear medicine at Stanford Health Care.

Ramp-up reality check
Domestic production of moly-99 could still be years away. European competitors warn, Goldman told the paper, that “this is more difficult than it looks. You can’t come up with a fancy slide that says, ‘I’m going to be producing moly-99 in a couple of years.’”

Pessimists and optimists
The 2016 National Academy of Sciences, Engineering and Medicine report demanded by Congress concluded that there was over a 50 percent chance of another severe shortage. That prompted industry leaders and the Nuclear Energy Agency to argue that foreign producers should work closely with the U.S. to keep the supply coming and to coordinate closures of plants for maintenance to ensure there is enough moly-99. “We’re describing a glass that is half full,” Charlton told the paper, “whereas the National Academies of Sciences sees the glass looking half empty.”

Still, others are less confident. “It is inconceivable to believe that an outage will never occur on any of these old reactors in the future,” said Dr. Joseph Hung, director of radiopharmaceutical operations at the Mayo Clinic.

Déjà vu all over again?
Finally, there is a lack of redundancy in the supply system that troubles some experts. “If anything goes wrong with the reactors in South Africa and Australia,” Hung warned, “it will be déjà vu again, like in 2009.”

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