amen
UNIVERSITY OF SASKATCHEWAN
UNIVERSITY HOSPITAL
DEPARTMENT OF DIAGNOSTIC RADIOLOGY SASKATOON, SASK.

H.P. KENT. M.B.

C.S. HOUSTON. M.D.
S.P.K. TCHANG. M.D.

G.P, GENEREUX. M.D.
S.P. PASTERSHANK, M.D.
S. YIP M.D.

K. CHOW. M.D. July 22, 1975

Dr. Joshua Lederberg

Dept. of Genetics
nN Stanford University School of Medicine
po. | PALA ALTO, California 94304

Dear Dr. Lederberg:

As a Professor in Diagnostic Radiology, I am concerned by the unwise
use of diagnostic radiation, particularly in children and in women of the
childbearing age. It is a sad commentary on medical thinking, or perhaps
merely another example of the apocryphal Murphy's Law, that the young
woman with the most vague, atypical and often insignificant symptoms,
receives the largest number of radiographic examinations. The less they
are indicated, the more she receives.

 

I teach our medical students that the following are not sufficient
indications for radiographs of the pelvic area of women under 45 years:
the patient expects it; the doctor wishes to appear thorough and not take
a remote risk of making a mistake; for reassurance of the patient; for
the curiosity of the doctor; for supposed medico-legal reasons; as a
Substitute for the doctor thinking; for something to do. I am convinced
there is a slight risk to all radiation and that there must be an expected
benefit to be balanced against the possible risk.

Doctors in general and even radiologists, Frequently come to me with
questions. The topics of inquiry are most often the maximum acceptable
dose for diagnostic procedures (there isn't any); the problems involved with
the ten-day rule; what to do when there is an inadvertent exposure to the
pregnant woman and is abortion ever indicated; and guidelines for use of
diagnostic radiation in the woman known to be pregnant.

I thought the BEIR report was excellent and feel that the findings
in it should be more widely disseminated to the medical profession to help
them deal with problems such as mentioned above. In this regard I was very
much intrigued by their extrapolations from your interesting calculations,
which you published as the Foreword to The Mutangenicity of Pesticides,
Concepts and Evaluation (MIT Press, Cambridge, Mass. 1971) and as "Squaring
an Infinite Circle, Radiobiology and the Value of Life" (Bulletin of
the Atomic Scientists 27: 43-45, Sept. 1971).

 
Dr. Lederberg 2 July 22, 1975

I have made a further paraphrase and extrapolation of the extra-
polation and would like to use it in the article I am preparing for
probable publication in the Canadian Medical Association Journal.

 

If you could spare the time, I would very much appreciate a note
to correct any fallacies in my understanding or calculations. I did not
think it was necessary to divide by the 30 year generation and then multiply
by the same 30 years, and although perfectly correct, thought this could
be left out of the calculations. It is entirely possible that I have not
fully comprehended every facet of your argument and that I have in my
ignorance misled my potential readers.

I would very much appreciate an early reply, either by mail or if
it is more convenient to you, I would be most appreciative if you would
phone me collect at my office 1-306-343-3041 or at my residence 1-306-
244-0742. (I will be leaving on a month's holiday on the evening of
Friday August 1).

Thanking you in anticipation.

Yours sincerely,

 

C. Stuart Houston, M.D.,F.R.C.P. (C),F.A.C.R.
CSH/ jm
encl.

P.S.: My classmate, Glen Lillington (M.D. Manitoba 1951) was a chest
physician at Stanford for a great many years and although it is a
large campus, you may possibly have run into him. He has recently
moved to DavisM as Head of the Department of Medicine there.

CSH