Congressional intransigence in providing reimbursement dollars, endless rounds of budget cuts, a preoccupation with over regulation and the pervasive residual effects of a broken healthcare system have combined to undermine nuclear medicine's promise.

Dr. Peter Conti, chairman of the SNM's Government Relations Committee and past Society president, said, "This is just the tip of the iceberg. More and more of the core activities in nuclear medicine are moving out of this country."
He says unfounded safety fears about nuclear products combined with Congressional inaction in getting CMS to approve reimbursements plus too many FDA regulations are harmful to nuclear medicine.
"As critical as this is, the real issue is the lack of investment to maintain nuclear technology in the US. Nuclear therapies are very safe," he added, "but the risks not rewards are making the headlines."

Moreover, Dr. Conti says alternatives for use in crisis situations like this one are available but again it's a matter of reimbursement and too much FDA regulation.

For example, he said that fluoride bone scans are the equal of those using technetium 99. "Hundreds of cyclotrons are out there and could be producing immediately." That's unlikely, however, given Congress's intransigence at loosening the reimbursement purse strings.

Meanwhile, in Canada, the reactor closed on Nov. 18 for maintenance and was scheduled to open five days later. It didn't happen. Atomic Energy's wholesaler, MDS Nordion, initially said full production would not likely resume until mid-January, 2008 at the earliest. It's estimated that MDS supplies approximately 50 percent of the world's isotopes for use in nuclear medicine.
AECL had advised MDS Nordion that a further extension of the maintenance shutdown at the reactor was required to complete upgrades to address regulatory issues. Of primary concern, the fifty-year-old reactor needs two new motor starters for the reactor cooling pumps, which then also need to be connected to an emergency backup power supply.

Because the isotopes created by the reactor decay rapidly and thus cannot be stockpiled, shortages have been felt at hospitals and medical centers in the US and Canada, as well as the rest of the world.

In Canada, for example, Dr. Kevin Forkheim, Director of Nuclear Medicine for Vancouver Island, British Columbia suggested the medical community was caught off guard by the news. "There was no lead time," he said. "People need these tests in a timely manner. There are no other suppliers."

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