Michael Reese's Pandora's Box

What happened when a box containing the names of 5,266 former patients, who had been treated as children with radiation to the head and neck, was found in a hospital in Chicago? What should a hospital do, knowing that these patients are at increased risk for developing cancer? This is the story of how a responsible ethical decision made at Michael Reese Medical Center to contact former patients led to a nationwide campaign launched by the National Institute of Health (NIH) together with the National Cancer Institute (NCI), to warn the public about the late effects of ionizing radiation.In 1973, a study at the University of Chicago confirmed suspicions that linked irradiation treatment in childhood given for a variety of infectious and inflammatory diseases (such as enlargement of the thymus gland, hypertrophy of tonsils and adenoids, ringworm and acne) to thyroid cancer. A few months later, a worker at Michael Reese found a box containing a registry of patients who had been treated with radiation. Hospital officials, after deliberating whether or not to act, decided to contact these patients and to arrange for follow-up medical examinations. To facilitate the program, letters were promptly sent out and phone calls made to all those in question. This decision at Michael Reese had a snowball effect influencing hundreds of other hospitals to follow suit.Media coverage of the Michael Reese campaign was extensive. Although some hospitals were reluctant to act for fear of damaging their reputations and creating legal problems, many other medical centers decided to contact former patients who had received radiation as children. On July 13, 1977, the NCI together with the NIH launched a campaign in the media to warn the public and the medical community of the long-term risks of therapeutic irradiation. Based on official protocols, formal announcements, court rulings, newspaper archives, and other documentary evidence, this study describes how the action initiated at one hospital resulted in widespread responses in other medical institutions and ultimately led to a nationwide campaign by health authorities.
Three learning objectives:1. What is the obligation of medical institutions to warn their patients of the possible consequences of medical treatment even after a long time has elapsed?2. What can we learn about decision-making policy in health care settings when the adverse effects of certain medical procedures result from standard, acceptable medical treatment and not from medical malpractice?3. What was the sequence of events which led public health organizations such as NIH and NCI to expose the risks of radiation treatment to the public?