Radium Girls (The Dark Story of America's Shining Women)

Disclosures & Disclaimers: The author, Veena Calambur, is currently employed by Pfizer Inc. This article was written in Veena's personal capacity. The opinions expressed in this article are the author's own and do not reflect the view of Pfizer.

“Radium Girls” by Kate Moore is an eye-opening story about the underaged working-class women in radium factories in the 1910s and 1920s. Their job was to add radium paints to a range of objects from watches to aircraft instruments resulting in fatal exposure to radium poisoning.

There was a perniciously false belief that radium was actually very healthy for people and the substance was initially recognized as an informal medical treatment at the time. These women were hired as young teenagers to work on radium products, even helping with World War I supplies. They thought they were doing their patriotic duty while assuming they were getting immense health benefits along with receiving the highest wage for any working class job. In fact, they were instructed to speed up the painting process with the simple “lip, dip, paint” method in which the women would lick the paint brushes that were constantly getting too stiff with radium in order to meet the high demand. If they weren’t directly ingesting the radium they were often eating and taking breaks close to the products without concern for proper hygiene. The women were not salaried but rather paid by the number of completed dials creating an incentive to lick the radium-coated brushes repeatedly over the span of years.

The book goes into excruciating details of the effects of the radium on the girls. So many of the women had significant dental problems such as mouth sores, rotting teeth and necrosis of the jaw. The radium could also settle in any part of the body causing various cancers and anemias. The women who suffered often died at very young ages even years after they had quit the company.

“Radium Girls” goes not only into the ramifications of the exposure to radium but also discusses the truly gross negligence and active harm by the major corporations in the radium business. Companies such as Radium Dial and US Radium Corporation learned within a few years of mass scaling their production of radium’s toxicity, yet it took until the 1930s for the IIC labor group to find them guilty of violating the safety of the women employed. These companies were finally forced to pay out the medical care that was long overdue to treat their radium poisoning which is not fully curable. For all the pain and suffering the Radium Girls endured they helped to establish very important precedent for labor rights, labor safety, and litigation for occupational safety for decades to come.

A small but still important aspect of this story is the role of the medical community. While some doctors worked tirelessly to investigate what was going wrong with the women there were some unfortunately bad actors who played an active role in preventing or attempting to prevent these women from getting the care and compensation they deserved. Some of these companies hired doctors (or even in one case a philosopher who was making medical recommendations without proper qualifying degrees) not to investigate the potential harmful effects of radium but to protect the reputation of the company.

In the case of Radium Dial that was based in a small town in Ottawa, IL during the Depression years they knew that not only did they have a monopoly but the town was incredibly dependent on this company for their local economy. Workers complaining about the occupational safety standards and threatening to bring accountability to this company was simply unacceptable to this town. This company invested a lot in their public image; taking out full page ads in the local paper about how they were doing all they could to look out for potential issues with radium bringing trust to the local community. They allegedly paid off local doctors to misdiagnose the women with syphilis to ruin their reputation as this disease implied impropriety. As part of their public campaign to address radium concerns, Radium Dial hired doctors to evaluate their employees for radium toxicity. The doctors manipulated the reports and would only share results of the healthier girls and prevent the more obviously ill ones from even getting an exam.

It feels impossible to think of a company getting away with such behavior today. However, even if it is not as blatant sometimes it’s incredibly important to understand the context for which a physician today makes decisions on medical care which can impact patients.

In the United States, health care professionals can receive gifts and monetary compensation from pharmaceutical companies. Gifts can range from pens to high-paying advisory roles. While some studies find little or no impact to the quality of care1 multiple studies have shown that physicians who take more money from these industry connections have higher average prescribing costs that can burden patients (1). A 2016 study linked Medicare Part D public prescription data with open physician payment data to evaluate this relationship over nearly 700,000 prescribing physicians. The study found that the highest prescribed physician groups had significantly higher costs per patient ($1,437 per patient on average) compared to all other physicians ($867 per patient on average) and per claim ($87 per claim versus $71 per claim) (2). A similar study focusing on prescribing physicians in the Washington DC area had similar results. The DC study found that physicians who received less than $500 per year from the pharmaceutical industry had more expensive claims ($114 vs. $85) and more branded claims (30.3% vs. 25.7%) than physicians who received no gifts. And physicians receiving more than $500 annually had the highest average costs per claim ($189) and branded claims (39.9%) than other physicians (5). This higher cost can stem from a higher proportion of branded versus generic medications as generics can cost 80-85% less than their branded counterparts according to the FDA (3).

Increasing costs for medical care has been shown to be associated with worse patient outcomes. If medical care becomes cost prohibitive then patients may feel pressured to not properly adhere to their medication such as stopping after some time or taking reduced quantities to spread the medication over time or even avoid treatment entirely (4). The Kaiser Family Foundation in their health tracking poll revealed that 29% of Americans do not take their prescribed medications due to cost and 8% reported their conditions worsened as a result of not taking their recommended prescription (6).

There has been some limited progress in trying to at least bring transparency to the financial ties between healthcare providers and the pharmaceutical industry. The Physician Payment Sunshine Act as part of the Affordable Care Act requires disclosure of pharmaceutical industry payments resulting in the release of the Open Payments database from the Center of Medicare and Medicaid Services (CMS) in 2013, which is the source of majority of the data in the studies mentioned in this article. This is not a complete picture of the financial ties between a medical provider and the pharmaceutical company as there are certain expenditure reporting exemptions. For example, large meal gatherings like buffet style food would be difficult to track which healthcare providers were present. So CMS decided to leave large meal reporting out. They also decided to exclude industry grants that fund continuing education for physicians. This has resulted in significant gaps in officially disclosed financial ties in the magnitude of millions of dollars (7).

Even though patients can look up whether or not their physicians are taking industry payments, a study found that patients are still largely unaware or unconcerned if their own physicians received industry payments (8). But once patients learn of their own physician’s financial ties to the pharmaceutical industry they may start to think otherwise. A survey reported in BMJ Open (9) found that patients were less likely than physicians to think that gifts were appropriate and that they were more likely to be influential to medical decisions. In fact, about one third of the patient participants thought that the cost of these gifts would be a burden passed onto the patients themselves (9) and nearly a quarter of patient participants reported that their perception of the medical field was completely altered after learning about the concept of industry payments and gifts to physicians.

Imagine if the women from “Radium Girls” had the tools to uncover the financial ties of the physicians who were falsifying their diagnoses. While the medical profession today is not nearly as dire as described in “Radium Girls” there is still a need for better patient awareness of physician-industry connections. Broader transparency can empower patients to understand the implications to their own healthcare decisions and resulting cost and burden and may potentially improve their outcomes.

References

1. Spurling, G. K., Mansfield, P. R., Montgomery, B. D., Lexchin, J., Doust, J., Othman, N., & Vitry, A. I. (2010). Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review. PLoS medicine, 7(10), e1000352. https://doi.org/10.1371/journal.pmed.1000352

2. Perlis, R. H., & Perlis, C. S. (2016). Physician Payments from Industry Are Associated with Greater Medicare Part D Prescribing Costs. PloS one, 11(5), e0155474. https://doi.org/10.1371/journal.pone.0155474

3. https://www.fda.gov/drugs/questions-answers/generic-drugs-questions-answers#:~:text=The%20reduction%20in%20upfront%20research,of%20the%20brand%2Dname%20medicine.

4. https://www.health.harvard.edu/drugs-and-medications/the-cost-of-generic-and-name-brand-drugs

5. Wood SF, Podrasky J, McMonagle MA, Raveendran J, Bysshe T, Hogenmiller A, et al. (2017) Influence of pharmaceutical marketing on Medicare prescriptions in the District of Columbia. PLoS ONE 12(10): e0186060. https://doi.org/ 10.1371/journal.pone.0186060Editor: Tomasz Bochenek, Jagielloni

6. https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-february-2019-prescription-drugs/

7. Lichter, P. R., MD. (2015). Implications of the Sunshine Act Revelations, Loopholes, and Impact. American Academy of Opthamology, 122(4), 653-655. doi:https://doi.org/10.1016/j.ophtha.2014.12.029

8. Kanter GP, Carpenter D, Lehmann L, et alEffect of the public disclosure of industry payments information on patients: results from a population-based natural experimentBMJ Open 2019;9:e024020. doi: 10.1136/bmjopen-2018-024020

9. Gibbons, R. V., Landry, F. J., Blouch, D. L., Jones, D. L., Williams, F. K., Lucey, C. R., & Kroenke, K. (1998). A comparison of physicians' and patients' attitudes toward pharmaceutical industry gifts. Journal of general internal medicine, 13(3), 151–154. https://doi.org/10.1046/j.1525-1497.1998.00048.x