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Machine-read from the scan, so expect some errors. Lines that couldn’t be read are left out.
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Assistant Administrator for Environment and Safety U.S. Energy Research and Development Administration Enclosed isa suggested revision of your draft letter tothe I have gone over this carefully with Vic Bond andU tirik people. Gene Cronkite to incorporate our combined changes and additions. You will note that the letter is written in a more scientific vein i n view of possible legal involvement. I hope that you have approved the meeting with the Marshallese * representatives arid i f so have been able to get out the necessary letters to instigate the meeting. It would be desirable to hold this meeting as soon 2s possible and i n view of the logistics problems involved i t may be early December before i t could be held, On the letter to Mr. Coleman I suggest you add for copies the names a f Congressman John Hag le lg m, Congress of Micronesia, Siapan Nariana Islands 96950 and Dr. Ezra Rilcloti, Director of Health Services, Majuro, Marshall Islands 96960.
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To The Chief-s and All The People in Uti rik Atoll : Your letter to Mr. Roger Ray, dated July 1976,has been received i n this office and w e wish t o thank you for bringing your thoughts toour attention.We have carefully considered your views and the opportunity t o answer your questions is appreciated. I.’oflowi;ig the accirient i n 1354 the he rican physicians ~ ? n dscientlisLs involved, based on knowledge of human radiation effects available at that time, did not believe that the dose estimated t o have been received by the Utirik people would lead to diseases caused by radiation. Also, since they had shown us)acute effects and only as light statistical depression of platelet counts, they were returned to.their home island. However, itwas considered prudent that the Uti rik people should be examined at regular intervals and they were given complete physical ex mi nations in 1957, 1959, 1963, 1966, 1969, 1972 and 1375. During the past six years special attention has been paid to thyroid examinations on an annual basis and all of the people on the is1m-d have been encouraged t o be exvnined and treated by the physic ims at sick call. Since 1973 the resident physician has visited Uti rik on a quarterly basis. Laboratory t o continue and expand the program initiated by Broolchaven and first carri zd out by Dr. Knudsen. D r . Kotrady was employed by Brookhaven National I n conducting the medical examinations on the Pfarshallese, a coniparison (control) group was selected so that the exposed and non-exposed people could be compared. This comparison group was selected in 1958 Erom the unexposed people of Rongelap. people from Uti rik was not considered necessary since the Rongelap group was considered adequate f o r comparison with both t h e peoples of Rongelap and A separate unexposed group of comparison The slight genetic difEerence between the two exposed populations
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and differences in doses received were not considered sufficient reasons t o select a - separate coinparison group for Uti rik. One o€ the questions concerned the fact that the children of the exposed islanders hme not been included in the regular exanination list. This was done because large groups of children of radiation-exposed parents of Ffarshallese children of exposed parents, revealed no distinct genetic effects, it was felt that regular examinations of the 'I.!arshallese children born of exposed parents was not necessary. To quote form a letter from one of the foremost human geneticists,Dr. J. V. Neel, Professor of Human Genetics atthe University o€ Michigan: I ! ...there is no evidence that genetic change was induced in children born of the exposed Marshallese any more than there is unequivocal evidence of damage inthe childr6.t born ofthe exposed Japanese." He pointed out, however, that there are some 15-20 dominantly inherited syndromes that might possibly be related to radiation exposure. Even i f one of these occurred, i t would be impossib leto say i t was due to radiation. It i s most unlikely that any Marshallese child would develop such a syndrome, Nevertheless, i f any child of an exposed Marshallese did, they would receive special treatment. A program for eu a a i nation of all children on Uti rik is discussed later in this letter. Several o f your questions suggest that the dose received by the Uti rik people might have been higher than calculated. received by both Rongelap and Uti rik people are inexact,a review of the data indicates that the dose estimates are reasonable estimates. There were marked early effects in the Rongelap people, but the lack o f acute symptoms and the minimal blood changes detectable by statistical means in Uti rik individuals is consistent with a small dose. The fact that the Uti rik people were returned Although t h e estimated doses
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to their home isla lid several months after the fallout would ~ c e thave contribute d increase in dose since surveys of the island revealed that the radiation levels were very low, b The radiation dose to the thyroid glands was higher than the dose to the rest of the body because of selective absorption by the thyroid of radio iodine s in he led and ingested from contaminated food and water a t the tine of the fallout. The radiation dose tothe thyroid glands of the Uti ril ; people was estimated t o be about 30 rad s for adults and between 30 agd 30 rad s for children compared with 335 rad s for adults and up t o 700 - 1400 rad s for children exposed on Rongelap. By the time the people returned to Uti rik the radio iodine s had virtually disappeared so that no further significant thyroid exposure was possible to anyone living on the island at that time. The development of thyroid cancer in the Uti rik people within the past few years was unexpected. Statistical comparison of thyroid cancer inci - dence at Uti rik with the larger experience of the United States indicates that radiation very likely was involved. tothe Department of Interior that all Uti rik people who have thyroid Accordingly it w a s recommended operations be considered for compensation similarly to the Rongelap peopl;?. Compared with limited data on the unexposed Marshallese populations there has been onlya very slight increase,if any, i n non-cancer thyroid nodules in the Uti rik people. The three cases of thyroid cancer i n the IJtirTk *I f used t h i s statement should be completed and checked out.
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people compared w<.th four In the Rongelap people is definitely higher than expected based on the estim.te.d close. However, we have rev i med the data and hav2 found no reason t o change the estimates of the dose to the thyroids of the Uti rik pe o plc. ‘The number of cases observed may vary above o r below the average number expected - the variation being larger as the population the predicted and observed nuiiber of cases may be substantial.Of course, thyrDic! cancer occurs i n populations not exposed to radiation above the natur zl background. The incidences of thyroid cancer varies with different popuiation groups. For example, in children the risk rate(in number of cases p’r million people per rad per year) varies fr on 0.5 t o 1.5 reported by the United Nations t o 5.5 fora group of Americans inNew York. It i s essential to know the natural incidence inthe Marshallese and larger studies or‘ such incidence have been initiated. Even though i t was known that the dose to the thyroid glands was higher than tothe rest of the body, what was not known during the earlier years was the degree of sensitivity of the thyroid gland to radiation. Even today, there are many facts about radiation that are not known, despite the large number of scientists that have studied this subject for the past twenty o r thirty years. Even less was known about radiation in 1954 at the time of the exposure tothe people on Rongelap and Uti rik. Only relatively recently has the degree of sensitivity of the thyroid for developing tumors from radiation exposure been appreciated. Therefore, the physicians ex mining you in past years, based on the best possible medical information available at that time, were being truthful &en they said that they did not espect radiation effects to develop inthe Utirilc people.
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At this time it i s impossible to predict whether more thyroid nodules will develop - in the Uti rik population. It is therefore of the greatest importance that the regular medical ex mi nations be continued in the future. By having regular medical ex mi nations,signs of thyroid disease can be detected early, and prompt treatment will avoid unnecessary suffering bn The medical team has been studying diabetes in the Uti rik people and other hlarshallese people. Though a study of this disease was not considered a resTon sibi lit y of the medical team s-ince the disease is not related to radi atl on exposure, it was considered important to help the Trust Territory with this disease which i s such a serious problem inthe Marshall Islands. With regard tothe use of Diabenase inthe treatment of this disease Dr. Janes Field,expert on diabetes from the University of Pittsburgh who had been studying diabetes in the Marshall Islands with the medical te,un, states that " there would be inherent risks in the use of the drug Diabenase in treating diabetes on Uti rik or other oct er islands in the Pfarshalls since long term medical supervision and laboratory tests are necessary to in sure its safe and effective use." With regard t o your comment about the reduced size of arrowroot plants on Uti rik,we can state that the results of studies of radiation effects on plants would not support radiation exposure as being responsible for a reduction in size of arrowroot o r of any other plants growing on Uti rik Atoll. Nuixerous studies of radiation on Utirilc show the 1evel.s have been too low t o result in such effects. We believeD rs. Cmard, Kotrady, and Knudsen t o be very capable and conscientious physicians who are deeply committed to the health and welfare
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of the people of Uti ril c. Rongelzp and Nti rik, which was fomed by the Congress of Xicronesia, vas Moreover, the report by the Special Comaittee on fcivor,zble with regard to the es mi nations.In view of the above, 172 c7ere greatly surprised to learn about the apparent displeasure on th2 part of the people of Utirik a s expressed i n your letter. One possible explanaas exprzssed i n your letter, could possibly be a misunderstanding as to their role ,~lld reasons t o come to the islands.I would like to repeat that it is my fixa conviction that the principal concern of Drs. Conard and ECnudsen i s the welfare and well-being of the Uti rik people. It is possible that such a misunderstanding could easily result from the difference in language. Again, I would appeal to the Chiefs of Uti rik to impress upon their people the importance of the medical examinations and the necessity to trust andcooperate with t h e American physicians. We would like to inform the Uti rik people that we anticipate introducing an expanded healthcare program for people living on Uti rik, Rongelap, Bikini. and Eniwetok. Such a program would include annual examinations by the physicians of everyone living on Uti rik island,including unexposed people and children, oadjZthe opportunity t o be seen at sick call during the quarterly visits of the physic im. We plan on holding a nee ting with a limited number of Marshallese representatives from each atoll in th2 near future to discuss these plans. We believe that such a meeting couid result in undzrstandings that will provide a basis for better healthcare for the people sf Uti rik.