6645_06_p375-380

THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 13, Number 3, 2007, pp. 375–379
Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2006.6213
Radioactive Pain Relief: Health Care Strategies and Risk Assessment Among Elderly Persons with ABSTRACT
Objectives: The aim of this study was to examine the use of radioactive radon therapy among persons with
arthritis, and to explore their perceptions of risk versus benefit in using this therapy.
Design: This was a qualitative study based on loosely-structured and open-ended interviews, which were
then analyzed for themes and patterns.
Setting: Participants in the study were recruited over a period of 5 years from clients of a radon health mine
Results: Sixty-two mine clients were interviewed, consisting of 36 women and 26 men, ranging in age from
60 to 92 years. Participants believed that radon therapy was an acceptable choice of treatment for arthritis. Per-ceived benefits of such therapy included more effective pain relief, avoidance of medication side-effects, lowercost, and increased quality of life. The possible future risk of lung cancer from radon exposure was seen asminimal when compared to the perceived benefits.
Conclusions: Fear about radon and its possible health risks seemed to have little influence on the decision-
making process for the study subjects.
INTRODUCTION
health hazard by environmental agencies because it seepsfrom bedrock and can build up to quite high concentrations Radioactive radon therapy is a pain-relief modality that in inadequately vented buildings.9 Exposure to high levels
is little known among practitioners of mainstream of radon has been correlated with an increased incidence of American medicine. First described half a century ago in lung cancer in uranium miners, although the correlation is popular magazines1 and in the Journal of the American Med- strongest among smokers.10 The U. S. Environmental Pro- ical Association,2 radon therapy continues to be used by hun- tection Agency (EPA) and its international equivalents have dreds of persons with arthritis sufferers in the United States tended to err on the side of caution with regard to exposure and thousands worldwide.3,4 In recent years radon therapy to radon, recommending mitigation of homes when radon has increasingly been studied by medical researchers, whose concentration is above a particular level specified by each reports have appeared in major medical journals as well as country. For example, mitigating action is recommended at in international conference proceedings examining the radon concentrations of 4 picoCuries per liter (pCi/L) of air health effects of low-dose radiation.5–8 or more in the United States, about 20 pCi/L in Canada, and Radon (radon 222) is a naturally occurring gaseous ele- anywhere from 5 to 11 pCi/L in other European countries.11 ment formed during the radioactive decay of uranium. Best Despite agency warnings, people in various parts of the known through publications and television commercials world intentionally expose themselves to radon, in curative warning the public of its dangers, radon is considered a mines, tunnels, and caves, and at upscale spas.3,5,6 Thera- Department of Anthropology, California State University, Fullerton, CA.
ERICKSON
peutic radon levels at all of these facilities are considered to multaneously.4–6 However, because radon is designated by constitute “low-dose radiation,” yet are very high in com- the EPA as the second leading cause of lung cancer, radon parison to EPA recommendations; for example, the Free En- therapy in the United States exists completely outside of the terprise Radon Health in Montana has an average radon con- biomedical health care system, and is never covered by med- ical insurance. As a result, it most assuredly fits the Amer- Radon is used primarily for its analgesic and anti-in- ican definition of an “alternative therapy.” flammatory properties. Consequently, it is applied to a wide Two frequently-cited major studies indicated that about 40% variety of conditions, including arthritis, rheumatism, fi- of the population of the United States saw alternative health bromyalgia, psoriasis, asthma, and bronchitis. The thera- practitioners during the time frame of the studies.15,16 Of those peutic use of radon involves the intake of radon gas either surveyed, the chronically ill were statistically most likely to through inhalation or by transcutaneous absorption of radon seek alternative therapies. Other studies have shown that pain dissolved in bath water. Most of the radon taken up is sub- is a powerful motivation to experiment with a wide range of sequently discharged through exhalation, but a small amount treatments, even bizarre or unusual ones.17 Persons with arthri- remains in the body as radioactive radon progeny (alpha par- tis are among the most likely groups to try new remedies, since ticles), which are physiologically active through their con- the conventional analgesic and anti-inflammatory medicines on tinued decay.11 Radon therapy in the form of inhalation or which they typically rely may become less effective over time bath or steam exposure can be obtained at a variety of clin- and cause severe side effects, in addition to being costly.18–21 ics, spas, or hot springs in Japan and Europe, where the ther- Recent correlations of several popular cyclooxygenase-2 apy is usually medically supervised, and may even be cov- (COX-2)-inhibitor medications with increased cardiovascular problems may cause even larger numbers of arthritis patients In sharp contrast, radon therapy in the United States is lim- to seek alternative means of pain relief.22,23 This article dis- ited to radon health mines in Montana, where it is a self-di- cusses the motivations and health care decisions of elderly peo- rected self-treatment. For this reason I refer to radon mine users ple who use radon therapy in the United States as an alterna- as “clients” rather than “patients.” “Therapy” consists of tive means of treatment for arthritis.
spending approximately 30 hours in the mine tunnel, spreadout over a period of 7 to 10 days, and taking in radon gas bysimply inhaling normally. Mine clients keep track of their hours in conformity with the suggested time limits; no med-ical personnel of any kind are available on the premises, and Since 1997 I have been studying the therapeutic use of no medical records or referrals are required for admittance.
radon at a “radon health mine” located in the mountains of The few caveats include advising pregnant women not to use west-central Montana. The mine’s clients are a self-selected the mine, and the standard rule that children under 18 years population who arrive from all over the United States and of age must be accompanied by a parent or guardian. Owners Canada, primarily during the summer months. The exact size of the 5 health mines I visited indicated that Montana’s De- and composition of the client group using the mine at any partment of Health and Environmental Sciences is aware of given time is therefore dynamic and unpredictable. Not only the radon health mines, but does not actively regulate them.† do people arrive at different times during the year, but they Advocates of radon therapy believe that at therapeutic do not necessarily visit the mine every year; some visit only doses, radon relieves arthritis pain and inflammation quite once and never return, while others have gone to the mine effectively. Because its effects are long lasting, and because nearly every year for 30 years or more. Most of the clien- it is relatively inexpensive, radon treatment allows many tele learn about the mines through word of mouth, although arthritis patients to discontinue using their conventional there are occasionally articles or brief segments in docu- medications for months at a time, thus providing them with mentary television programs about the mines. For example, relief from the side effects and high costs of medication si- the January 2004 issue of National Geographic magazinehad an article that featured one of the mines.‡ The individuals in the present study were limited to 62 self-identified persons with arthritis who were interviewed *Average radon concentration based on periodic monitoring us- between 1997 and 2002. This group included 36 women ing commercially available radon testers, with analysis done by and 26 men, many of them married couples, ranging in age Energy Laboratories in Helena, Montana (personal communicationfrom Patricia Lewis, owner of the Free Enterprise Mine, August from 60 to 92 years. Most of the men were retired, but they collectively represented many diverse occupations, includ- † Patricia Lewis has stated that the Department of Health and ing farmers, ranchers, carpenters, small business owners, Environmental Sciences of the States of Montana, at the state capi-tol in Helena, has expressed little interest or concern with the radonhealth mines since her grandfather first opened for business in1952, beyond publishing cautions for children and pregnant ‡Salak K. Mining for Miracles in Montana. National Geo- graphic, January 2004, pp. 118–122.
RADIOACTIVE PAIN RELIEF
printers, insurance salesmen, and retired members of the ing radon therapy. The physical conditions and pain levels United States military. Women in the study group pre- of mine clients varied widely; those with severe pain were dominantly described themselves as housewives, but articulate in describing it, as exemplified by the followingtheir present or former occupations included teaching, re- statements: “The pain is continual—it’s unremitting and op- tail clerking, office work, child care, and health care. The pressive. It’s as if a bonfire was lighted on my knees, el- place of residence for this group included various states and bows, wrists, and hands.” “I have pain daily with brief pe- riods of relief, but it always returns. Sometimes it’s nagging For purposes of the study, the term “arthritis” was used and annoying, but other times it’s unbearable.” very broadly. Although many interviewees said they had The hope that radon gas would relieve their pain was been formally diagnosed by an allopathic physician as hav- shared by all mine clients, and it clearly took precedence ing some form of osteoarthritis or rheumatoid arthritis, oth- over any sense of risk regarding exposure to radon. Study ers were self-diagnosed. Moreover, some participants de- participants admitted having heard that radon could be a can- scribed themselves as having arthritis in combination with cer risk factor, but without exception stated that any poten- fibromyalgia, bursitis, or rheumatism. I chose to use this tial risk was “worth it” if pain relief was the outcome. A broad interpretation because all participants indicated hav- few claimed to have studied the literature on indoor radon ing a range of similar symptoms, including joint and mus- risk and had nonetheless decided to try radon therapy, as re- cle pain, stiffness, limited range of motion, and generalized flected by the following comments: “Well, it was a last re- aching, in varying degrees of severity.
sort—I was feeling a lot of pain and hoped [radon] would Most participants stated that they routinely used various help. When you hurt you’ll try anything.” “The mine has types of over-the-counter (OTC) and/or nonsteroid prescription helped me more than anything. Sure, I’m concerned [about analgesic and anti-inflammatory drugs. In addition to these radon risk], but I think the danger may be overblown.” “I medicines, some mine visitors were undergoing treatments with evaluated the risk versus the potential benefit. I’m very open cortisone, prednisone, or gold injections, and a few had condi- to trying anything reasonable to get out of pain. I studied tions serious enough to require braces, wheelchairs or walkers, the evidence on this, and I felt it would possibly be of ben- or surgery. Most had been seeing a conventional physician on a regular basis, and about one-third had seen a complementary Quality-of-life issues were also important in making the or alternative practitioner in addition to their regular physician.
decision to risk radon therapy. The loss of autonomy and Some reported having experimented with a variety of alterna- independence in the activities of daily life—or the fear of tive treatments, including magnets, copper bracelets or other such a loss—was a prominent concern that seemed to over- copperware, vitamin and herb regimens, and home remedies, ride the potential risks of exposure to radon. A common all with limited success. In other words, radon therapy was theme was the hope of regaining the ability to participate in something chosen only after one or more types of other treat- enjoyable activities and hobbies, or for some very disabled individuals, to be able to walk or sit without continual pain.
Mine clients typically used the mine for 7 to 10 days, dur- Comments in this regard from three participants included: ing which time they stayed at local motels or in recreational “I didn’t have any quality of life the way I was going. Even vehicles at a camping area provided by the mine owners. A if this mine shortened my life by 10 years I would have cho- standard course of treatment was as follows: several times sen it immediately rather than go through the pain. Know- each day, mine clients entered the mine and remained there ing the trade-off, I’d have chosen the shorter life to be out for 1 to 2 hours. Between sessions in the mine, the clients of pain.” And “You lose your independence so much, and engaged in a variety of activities according to their health that’s hard on an individual as much as the pain. I always took pride in doing things myself, didn’t ask for help. So Interviews for the study were open-ended and structured that’s something else you have to learn to live with too. This only to the extent of being guided by a general set of topics mine has just been—well, it’s been a savior for us.” As well about which I hoped to elicit information. Primarily, I was in- as “I tell them, [radon] can’t hurt, you know. Even if it did terested in mine clients’ stories about how and why they de- hurt you down the line, if it takes away your pain you’re cided to use radon. Conversations were tape-recorded and later going to choose this life instead of that one anyway.” professionally transcribed in their entirety, after which I ana-lyzed the interview materials for themes and patterns.
Efficacy of radon versus adverse effects and costs ofconventional treatments Some participants said that in making the decision to risk radon therapy, they had asked themselves whether the potential of harm in the future (e.g., possibly getting lung Pain was the most frequently mentioned concern among cancer) could be any worse than other kinds of treatments the mine clients when discussing their motivations for try- they were currently taking. The posing of this question ERICKSON
seemed to help people to justify “taking the chance” with Perceptions about the EPA and medical profession exposure radioactive to a substance. A good example of In addition to the sharing of personal concerns, symptoms, this was provided by a 62-year-old woman who at the time and testimonials about radon, conversations with participants of interview was using radon therapy for arthritis in her also included critical comments about doctors and the med- hands. In the interview, she told an interesting story of ical profession in general, the pharmaceutical industry, and having first come to the mine nearly 10 years earlier to the government agencies that could potentially prevent mine bring her then 9-year-old granddaughter who had been di- clients from using radon in the future. In terms of EPA rec- agnosed with juvenile rheumatoid arthritis at the age of 2 ommendations there was a general tendency to view the years. By the time the granddaughter was 9 years old she “radon scare” as something that had been overplayed in the was taking a weekly regimen of injections of a drug also media for sensationalism, and for profit. One participant said: used for chemotherapy (the interviewee could not re- “There’s such a fear of radon in some parts of the coun- try; well, I think a lot of that is over-played just like a lot “I thought [radon] was too radical. But I kept thinking of things.” A second said: “In Florida there’s all kind of about it. I told my daughter [Sally’s mother] you needed a radon scares and everything else, and it’s in the newspaper doctor’s note for a child [to use radon]. We asked Sally’s and they get whole flocks of people to move out, and they rheumatologist but he said no. No way! Then we were at don’t find anything. Kind of the ‘sky is falling’ type oper- the pediatrician—Sally was having her weekly injection of ation with the radon.” And a third expressed the view that: the chemotherapy drug. We mentioned the mine to the pe- “There’s too much control by government and the medical diatrician, who then just pulled out her prescription pad and profession. Too many scare tactics are repeated in the press wrote out a note authorizing the radon treatment. She said, and on TV, and it scares people into not believing there ‘Do you think that the radon would be any worse than what could be help with (radon). People have spent millions to we’re injecting into this little child?’” A recurring theme among participants was the desire to Criticism of the medical profession was also a recurrent “kick the medicine cycle,” as one person put it. Oral med- theme. Because the owner of the mine provided copies of ications, when taken over a long period, had caused some scientific articles on the subject, mine clients were very mine clients to have bleeding in the stomach, liver prob- aware of radon therapy’s status in Europe as a biomedical lems, ulcers, migraine headache, kidney problems, and other treatment where, if not used by all medical doctors, it was severe side effects as their dosages had increased over time.
at least one of many choices available to arthritis patients.
“I’ve had rheumatoid arthritis for 30 years, mostly in my Believing that they themselves were being helped by radon, hands, feet, and knees,” said one participant. “I’ve had cor- but frustrated that radon’s “alternative” status in the United tisone shots, prednisone, and Tylenol. They recently put me States forced them to have to drive all the way to Montana, on some other pills (type unknown) that have side effects my informants expressed a common opinion that the med- that are terrible . . . they give me awful, terrific headaches ical profession (in both the United States and Canada) was and bother my stomach.” Another participant said: “I took either “too profit-oriented” or “too rigid” to explore the pos- Indocin, Naprosyn; you’ll try any kind of new medicine that sibilities of radon. Thus, one participant stated that: “The helps arthritis. The doctors are doing the best they can, but health care community, doctors and drug companies, are most of it isn’t good for your stomach or your hearing or afraid of the competition. A lot of doctors are not open- your sight. My ears started ringing from one of the drugs, minded—they only know how to dispense drugs.” And an- and I lost more hearing than what I did have before. The other said “There are too many ‘do-gooders’ that don’t have drugs also make you anemic. I had to start taking an iron a clue to the help (radon) does, nor do they want to learn. I supplement. All of this from those arthritis drugs!” think we’ve been grossly misinformed about the dangers of Cost of prescription drugs was a serious consideration radon. The AMA wouldn’t make a profit on it—it’s politi- for many of the study participants. One woman taking a cal. It would be a financial loss to doctors.” COX-2 inhibitor reported her cost for it to be $300 permonth, while another described having injections of cor-tisone and a cartilage-building substance that cost $500per series. A 75-year-old man claimed he had started get- CONCLUSIONS
ting his arthritis medicines from Mexico 20 years earlierbecause it was cheaper to do so. A married couple, both Pain, unrelieved by other remedies, was the most im- of whom were self-employed, had been driving to Mex- portant reason given by the participants in this study for ico for their prescription medicines because they couldn’t trying radon therapy. An important consideration in mak- afford health insurance. At about $150 for 10 days of ing their decisions was the level of success they had radon per year, these participants saw the mine as an af- achieved with other treatments for arthritis, and whether fordable alternative, provided one could afford to make or not these treatments were causing adverse effects. Par- ticipants hoped to cut back on their regular medications RADIOACTIVE PAIN RELIEF
or, ideally, to stop taking them altogether. Many partici- 9. U.S. Environmental Protection Agency (EPA). A Citizen’s pants hoped that radon would increase their quality of life.
Guide to Radon: The Guide to Protecting Yourself and Your In addition to their experience of a lack of efficacy and Family from Radon. U.S. EPA 402-K02-006, Revised Sep- of side effects of the conventional treatments, they also tember 2005. Online document at: www.epa.gov/radon/ cited cost as an important factor in their choosing radon pubs/citguide.html. Accessed June 2, 2006.
10. Krewski D, Lubin JH, Zielinski JM, et al. Residential radon therapy. Specific fears about danger from radon seemed and risk of lung cancer. Epidemiology 2005;16:137–145.
to have very little influence on their overall decision-mak- 11. Alavanja M, Lubin J, Mahaffey J, Brownson, R. Residential ing. In comparing the perceived benefits of using radon radon exposure and risk of lung cancer in Missouri. Am J Pub- therapy, versus the potential risks of radon exposure, these mine clients concluded that for them, using radon therapy 12. Falkenbach A. Rheumatic pain in elderly patients with anky- losing spondylitis during a three-week course of radon-speleotherapy. Rehabilitation 2001;34:171–173.
13. Mifune M, Sobue T, Arimoto H. et al. Cancer mortality sur- vey in a spa area (Misasa, Japan) with a high radon back- ACKNOWLEDGMENTS
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14. Falkenbach A. Speleotherapeutic radon exposure of a child I am grateful to the reviewers for their helpful sugges- suffering from juvenile chronic arthritis. J Altern Complement tions to improve this article. This study was funded by grants from the University of Nevada, Reno, and The Sanford Cen- 15. Eisenberg D, Kessler R, Foster C, et al. Unconventional med- ter for Aging at the University of Nevada, Reno, Nevada, icine in the United States: Prevalence, costs, and patterns of and California State University, Fullerton, California. I am use. N Engl J Med 1993;328:246–252.
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Source: http://anthro.fullerton.edu/berickson/JACM%202007.pdf