In what seems like a throwback to the days when quack medical products included radium, causing people's jaws to fall off from cancer, some people are once again turning to a carcinogenic radioactive element for their health. This time it's not radium but radon, an alpha particle emitter, and second only to smoking as a cause of deaths from lung cancer. The benefit, they say, is pain relief, or treatment of high blood pressure, or — in the ultimate irony — treating cancer. It is not an approved therapy in the United States (though it is in some other countries), so the playing field is wide open for anyone who wants to sell it, and anyone who wants to try using it.
Radon therapy is given in two ways. First, most common in the United States, is for it to be inhaled, usually in abandoned mine tunnels, as radon is constantly being produced by the decay of heavier radioactive elements in the rock. Second, most common in Europe and Japan, is for it to be given as a bath in warm water infused with radon gas. It is absorbed through the skin and into the bloodstream, and can be found in the air the patient exhales quite quickly. So both methods get radon into the lungs quite effectively, which is why radon's primary effect on the body is to cause lung cancer. However, the belief is that the alpha particles bombarding the lung tissue will also produce some kind of beneficial effect.
The effect that the believers are hoping for is called radiation hormesis, which is a complex topic, and was discussed in detail in Skeptoid episode #539, so listen to that one if you'd like to know more about it. But the short version is that some people believe extremely small amounts of radiation are medically helpful rather than harmful. They often compare it to the way a vaccine works: you can challenge your body to respond to an attack, and it will strengthen the body's defenses. But vaccines work because they stimulate the production of immune cells designed to fight a specific disease. Radiation is not a disease that your immune system fights; radiation is a bombardment of tiny particles that destroy your DNA. There is no immune cell that defends against that; and a body cannot be strengthened against it.
Radiation hormesis has been studied extensively, due to high consumer interest in its potential. The data is inconclusive, with results all over the place. The reason is because the results are all basically below the noise level. Researchers have to look for health effects from radiation levels that are at or near the background noise level, so with data that's essentially random noise, no trends can be drawn. So if there is a positive effect, it's so small that it's statistically undetectable.
However, unlike radiation hormesis which uses low doses of radiation, radon spas expose the patients to high levels. Skeptoid #698 was all about radon gas that may be present in your home, and whether you need to worry about it. The short answer is that you do, at least enough to get tested. The Environmental Protection Agency established 4 pCi/L (picocuries per liter) as the action level, meaning that if you have more than that in the air of your home, you need to take steps to mitigate it, as that means you have a real chance of getting lung cancer. But in the radon spas located in mines in the United States, levels are up to 1600 pCi/L; 400 times the EPA action level.
Let's do a direct comparison. A typical recommended course in a radon spa is 32 hours. Since being in there gives you up to 400 times the exposure level of a house at the EPA action level, a trip to the radon spa is like spending 12,800 hours in such a house. Since the average American spends about 60% of their time in their house, that many hours is like living there for two and a half years. But that's only one treatment; most radon spa customers are repeat visitors; how often they come is all over the map. Each time they take such a treatment, it's the equivalent of two and a half years in a house the EPA says is too dangerous to live in.
I'll leave it to you to guess whether any medical researcher would recommend such treatments just to obtain the completely uncertain and undetectable benefits some believe it might provide, in addition to the guaranteed lung cancer risk.
And yet, people keep going, and they keep reporting pain relief. So what's going on?
For four years beginning in 2007, anthropologist Dr. Barbara Erickson visited various radon spas in the United States and Europe with a population of people suffering from arthritis pain, to see and how people used these facilities, and to learn about the facilities themselves. Her paper was published in the journal Dose-Response as a study of the human dimension of radon therapy. Dose-Response is a journal noted for its friendliness toward radiation hormesis, so most of the published research on radon therapy is found there. Her paper made a number of interesting observations:
In a separate article, I think Dr. Erickson's abstract included a great succinct explanation for why these clients keep going:
Put all of that together and it means there are plenty of reasons for fallible humans to try radon therapy — and even to keep going back for more — regardless of whether it actually works or not. But that's really the operative question here, so let's have a look at what little research exists to see what it says. And it is indeed a little research; very few studies are conducted in a field that requires subjecting humans to high doses of carcinogenic radiation. Thus the studies that do exist are mostly observational studies of the people who are already going for radon therapy, so important study components like blinding and control groups are often not included. And indeed, many of the studies are conducted by the spas themselves, predictably giving positive results, as determined by reduced usage of pain medications after six months. Every single study I found had either unacceptable conflicts of interest or worthless methodology.
Most of the studies I found used baths located at the European radon spas as the delivery method, and all used existing clients of these spas as the test subjects. When a control group was used, the sham placebo treatment was a carbon dioxide bath — basically bathing in warm soda water — which many of these spas also offer as a regular therapy. Regular clients would be familiar with both: a carbon dioxide bath is fizzy, while a radon bath is not. To them it's quite obvious which one they're in, so for the study authors to say that their test was randomized and blinded is not very persuasive. In one study, many patients declined to participate after being told that if they were randomized into the carbon dioxide group they wouldn't get to have the radon baths they wanted; in another study, the groups were switched halfway through so that all study participants got both bath types.
Studies coming out of Japan tend to use the inhalation method, which is much easier to make blinded because radon is colorless and odorless and you can't tell if it's in the air you breathe. One study I read (again, published in our old friend Dose-Response) tested it as a treatment for cancer; they had one patient for each of four types of cancer, all four of whom had also received conventional cancer treatment. Although the paper frankly admits in each case study that there's no way to tell if the improvement was from the conventional cancer treatment or from the radon, its conclusion still manages find that the radon appears to be an effective cancer treatment.
So here's where I'm coming down on radon therapy, pending additional information. Nearly all the published work finding that it's beneficial comes from low quality studies published in a journal that's basically dedicated to the promotion of radiation hormesis, a fringe idea not supported by most scientists and not supported by good evidence. All radon therapy is dangerous and definitely does increase your risk of lung cancer, though not enormously, and on a timescale that is probably not relevant for most elderly people. It's certainly not as bad as drinking radium 100 years ago, but it's cut from the same cloth. Its most significant effect is to transfer money from your pocket to the pockets of those who sell it. So at this point, the Skeptoid recommendation is to pass.
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