On Oct. 1, 2009, the Michigan Department of Community Health offered a $63,000 fix for what it called an "impossible" scenario: a disaster at one of the state's three nuclear plants.
If radioactive material spread across a 10-mile area, and if residents were told to take shelter in their homes rather than evacuate (the preferred action in the state's emergency plan), the affected population might survive the initial damage — thermal burns, internal bleeding, leukemia and cataracts — only to suffer, 20 years later, from symptoms of thyroid cancer.
They likely would survive that, too, as 95 percent of all radiation-related thyroid cancers are curable.
It's a worst-case scenario with the best possible ending. And there is virtually no chance of it happening.
"The assumptions that were used in our models of a catastrophic accident at a U.S. nuclear plant were so conservative that they were unrealistic," says Patricia Milligan, the senior adviser for emergency preparedness and response at the U.S. Nuclear Regulatory Commission. "It just isn't likely to happen."
So why has the commission purchased 14 million tablets of potassium iodide, also called KI, to be given to Americans who live within 10 miles of a nuclear facility? And why do it now?
The NRC has provided the pills to 23 states. In Michigan, the MDCH has issued them to pharmacies, which will make them available at no charge to anyone who lives near the state's three nuclear facilities: the D.C. Cook plant in Berrien County, the Palisades reactor in Van Buren County and the Fermi plant in Monroe County.
The nuclear companies will pay the state $63,000 to advertise and distribute Michigan's 1.3 million tablets. The NRC paid for the pills.
The tablets saturate the thyroid gland. If taken within hours of a nuclear release, they can block the body from absorbing radioactive iodine, which can cause thyroid cancer.
The KI program is a direct response to the Chernobyl accident, which contaminated much of Belarus, Ukraine and Russia in 1986. The incident is the worst nuclear failure on record: More than 240,000 people were exposed to high doses of radiation, and another 346,000 had to relocate.
Radioactive iodine from the Chernobyl reactor was disbursed into nearby farm pastures. The cows that grazed in those areas passed the contaminant into their milk, which was bottled and served to local children.
More than 5,000 of those children now have thyroid cancer, the World Health Organization reports.
Chernobyl is not a perfect case study. The reactor did not operate with the safeguards in place at modern nuclear facilities in the U.S. MDCH officials point to that in a fact sheet explaining the KI program:
"Michigan's (nuclear power plants) are extremely safe," the paper says. "In fact, an accident like that at Chernobyl or Three Mile Island would be impossible because of the design of Michigan's plants." (A partial meltdown at the Three Mile Island nuclear plant in Pennsylvania on March 28, 1979, was the worst nuclear accident in U.S. history; no deaths or health effects were reported.)
So why bother?
The answer stems from a very different event: the Sept. 11, 2001, terrorist attacks.
The NRC, having completed its Chernobyl studies, required that states consider KI distribution beginning in April 2001. That September, after the attacks on the Pentagon and World Trade Center, states began to request the tablets.
"A lot of people assumed that the KI program was a response to the Sept. 11 attacks," Milligan says. "It wasn't. But Sept. 11 did make some states more aware of the political pressures."
New York asked for tablets first. Several New England states followed. Actual demand for the tablets was another matter: Just 10 percent of the eligible population responded to New York's initial KI distribution, the NRC says.
Michigan waited for additional KI studies. In 2004, the National Research Council endorsed KI programs, which had begun in 21 states. Officials at the MDCH and the Michigan Department of Environmental Quality began discussing how best to distribute the pills.
Some in the state already had access to them. The Emergency Management and Homeland Security Division of the Michigan State Police has maintained a 3,200-bottle stockpile of KI since the early 1990s. That program will continue, the MDCH says.
The state requested an additional public supply of KI in February 2008. A manufacturing delay postponed the program for more than a year, as several states had ordered new batches of KI to replace their tablets, which had expired before anyone needed them.
That will happen again. The NRC has assumed the cost of replenishing the KI stockpiles. The commission plans to spend between $4 million and $5 million every six years to refresh the pill supplies.
 "Thyroid Cancer - Papillary Carcinoma," The New York Times, March 21, 2008, http://health.nytimes.com/health/guides/disease/thyroid-cancer-papillary-carcinoma/overview.html (accessed Jan. 13, 2010).
 World Health Organization, Fact Sheet No. 303, April 2006.
 "Distribution and Administration of Potassium Iodide in the Event of A Nuclear Incident," National Academies Press, 2004.
 Notation vote, "Recommendation for Future Replenishment of Potassium Iodide," March 3, 2009.