Radiation, Still Misunderstood after All These Years 

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The authors give a well-balanced look at radiation’s dangers and benefits, beginning with an effective explanation of the radiation-induced oncogenic process and some of the book’s most interesting stories, even treating the readers to a couple of radiation murder capers.

Over the past few decades, radiation therapies have rapidly advanced, due, in large part, to an increasing technologic armamentarium. Among modern science’s most impressive machines, for example, 220-ton particle accelerators can generate near-light-speed beams of protons, with sniper-like precision, to their tumor targets. Hence, of the three oncologic disciplines, radiation oncology is perhaps the least understood, especially among patients. People can reduce oncologic surgery to the scalpel and medical oncology to cancer-killing chemicals, but that easy-to-grasp reductionism defies radiation therapy’s exotic particles and rays.

After all, radiation both kills and cures. Its awesome energy can reduce a major city to a charred moonscape or direct a curative beam into an intraocular tumor. It is no small task to conflate our knowledge about radiation into a readable book, but that is what Robert Peter Gale, MD, and Eric Lax partnered to do with Radiation: What It Is, What You Need to Know. For the most part, Dr. Gale and Mr. Lax offer readers a good, thoroughly informative read.

Minor Gripes

Using the 2011 Fukushima Daiichi nuclear power plant catastrophe in Japan as the most recent reason to fear radiation, the authors’ preface, “A Note to the Reader,” begins with a sort of caveat: “Virtually everything is radioactive, including us; some things are just more radioactive than others.” The preface ends with, “Frightening as the topic of this book might be in some ways, information and education can relieve some, if not most, anxiety about radiation.”

Legendary editor Harold Ross once famously declared about his new magazine, The New Yorker, “it is not edited for the old lady in Dubuque.” Similarly, Radiation, with its sometimes-dense reading, is not for readers who don’t have an affinity for science books. So the cautionary preface seems unnecessary and a bit condescending. That’s a small gripe, but in a book that expects its readers to follow quantity comparisons of thorium-230 and uranium-234, it’s worth noting.

To their credit, the authors give a panoramic view of radiation within a neat package of a few hundred pages. Another pleasant surprise is the eye-pleasing text, set in Times New Roman—unusual for a book. The book’s architecture is another winner, organized in nine chapters with well-thought-out subheads—it suits a cover-to-cover reader or one looking to peruse and skip.

On that note, another minor gripe. I’m not sure what percentage of readers pass over a book’s introduction, especially if it runs more than a page or two, but enough do, so authors should heed this caveat: If you’ve written a compelling, 20-page info-jammed introduction (as is the case with Radiation), call it Chapter 1 instead of Introduction.

To illustrate the power of radiation, the authors begin their introduction with a throat-grabbing tale that takes place in Brazil in 1985, in which a custody battle over a radiation therapy machine sets off a medical mystery drama that could be a made-for-TV movie. Do not skip the introduction.

Balancing Act

Chapter 1, “Assessing the Risks,” delves into the possibilities of developing cancer from radiation. It begins on July 16, 1945, in a desert in New Mexico where the explosion of the Trinity test—the first atomic bomb—“generated a light brighter than any ever seen on Earth.”

After an arresting opening, the pages begins to crawl across the desert of radionuclides and microsieverts until the authors declare, “Having slogged through so many technicalities, let’s examine how scientists analyze radiation emitted, energy absorbed, and biological damage from that radiation, so that we can make the one judgment that really matters: What am I exposed to, and is it bad for me?”

Radiation is a technically challenging subject, and the authors do a good job “slogging” through the very dense but necessary scientific explanations, after which, their inner storytellers take off, deftly using anecdotes and snippets from radiation’s interesting history. This balancing act between dense science and highly readable storytelling usually gets the necessary yin-yang right.

Radiation, Cancer, and Medicine

As for chapters of special interest to readers of The ASCO Post, chapter 4, “Radiation and Cancer.” and chapter 6, “Radiation and Medicine,” jump out. In chapter 4, the authors give a well-balanced look at radiation’s dangers and benefits, beginning with an effective explanation of the radiation-induced oncogenic process and some of the book’s most interesting stories, even treating the readers to a couple of radiation murder capers. The treatment of UV exposure and skin cancers is packed with good information, some myth-busting included.

Chapter 6 wades into some rough waters, tackling the always-controversial area of breast and lung cancer screening. The authors make what some in the oncology community might feel to be facile arguments, such as: “From a radiobiology perspective, screening mammograms are a good example of the benefits (early diagnosis of breast cancer) exceeding the potential risks (exposure to ionizing radiations).” If only it were that simple.

Final Pages

The authors have added a smartly put-together Q&A following the last chapter. This is not an easy thing to do, but it has the feel of an ASCO meeting, when audience members amble up to the mikes.

That last chapter, “Summing Up,” begins with an unnecessary apology: “To the readers who struggled through these 206 pages of complex, sometimes dense text referencing controversial and unresolved viewpoints, our admiration and gratitude.” There is no reason to apologize for dense text in a science-subject book, especially when parts are well written, entertaining, and informative.

However, also in the “Summing Up” chapter is the following statement: “One-half of our annual radiation exposure comes from medical procedures of which one-third or one-half may be unnecessary.” There is no referenced supportive data to back up this rather bold claim. As science writers, the authors should know better. Maybe here an apology is necessary.

That said, despite a few potholes, Radiation is worth the ride. ■