Facsimile Cover Sheet to W H Weyzen (Attached: Draft Report on the Marshallese Residents)

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The people of Rongelap Atoll wrote a letter, dated October, 1976, toDr. J. L. Liverman of ERDA containing a series of cm ents and questions about the medical program on their island.A copy of this letter is attached. The following comments concerning the ' letter were prepsred by the staff of Brookhaven National Laboratory and ERDA. The first comment i s with regard to travel of Plarshallese patients to the United States. Since only very few Americans know the > kr shall ese language, itis indeed necessary t o accompany patients chat coiile tothe U.S. for treatment by Marshallese attendants. occasions, this did not occur for various reasons. Every effort will be made in the future to have all patients accompanied by ZngLish-spe&ing Unfortunately, OR o r about two Marshallese attendants. Also when traveling outside the .Trust Territory, they will be provided with adequate t save ling funds. Territory officials will be urged t o arrange necessary papers such as passports well in advance. Whenever the Brookhaven doctors are a t sickness the best treatment available under past, any disease in an exposed person that tion exposure will be taken to the U.S.for Rongelap, they give vlyone with appears t o be caused by ' radia - the case that adequate facilities are available locally,patients that require hospitalization will be treated in the Trust Territory hospitals. Dr. Knudsen will assist inthe treatment of the patients at these hospitals. Medicines needed for treatment a t Rongelap that are not available from the Trust Territory Department of Health Services will,if possible, be provided by ERDA doctors. We are sorry that there have been conflicting reports about the future health of the exposed people of Rongelap. Specifically, we strongly disagree with the Japanese newspaper report that is is necessary t o leave Xongelap

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because of -the radiation levels on the atoll. There has 32en =any tests of soil,plants, whater on the island, and measurements oi urine and radia - tion in the people living on Rongelap. These tests shr; chat the levels are low and they are getting less and less. The little bit of radiation left on the island would not be expected t o cause any he zl th effects. We are pleased that Dr. Naidu was able to visit you and eq la in about radia - tion and its effects.We hope t o have other scientists,possibly sone from other countries,visit Rongelap in the future to continue this educa- .Atthe time of the fallout in 1954 the radiation dose tothe thyroid glands was higher than the dose tothe rest of the body because of selective absorption by the thyroid of radio iodine s inhaled and kngested frm contamin a ted food and water a t the time of the fallout(see B ble I). The radia - tion dose to the thyroid glands of the Rongelap people xes est hated to be about 335 rad s for adults and up t o 700-1400 rad s for children. time the people returned to Rongelap the radio iodine s had virtually d is - appeared so that no further su gni fi cant thyroid exposure w2s possible to anyone living on the island since that time. among the people that thyroid nodules that develop i n mexposed people living on Rongelap are caused by lingering radiation. radiation is too small to produce thyroid effects. i n people living throughout the Marshall Is lv lds which are, of course, not There has been a false belief ' The dose fra the lingering Th poi d nodules occur due to radiation exposure.

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We are pleased about the remarks made i n your letter about the Brookhaven and the other fine doctors that have taken part in the i ed ical pro gra. We are sure they always had your welfare at heart. ERDA has a great deal of. confidence i n Drs. Conard a d Knudsen W e are convinced that the medical examinations of the Rongelap people have been very thorough and complete with many tests on the pe ol lead on their blood, urine,etc. Some of the most skillful doctors in the U.S. and from other countries have taken part in these examinetions. the best equipment possible that can be taken t o the is lu ld. They have used ' You can be sure that the examination program ensures early diagnosis and treat oen t of Currently, arrangements are being discussed t o ; )zixit 211 the people living on Rongelap, including children,to have an exd nation et least once ayear by the Brookhaven doctors. We have plans with tie Trust Territory to further education for the Health Aides in the diagnosis and treat - realize that at the time of the annual examinations, there is suf - disruption of life and that the team should provide additional food. Therefore a sufficient amount of food will be furnished by the tea during t h e period of the examination. Members of our staffs have had several discussions with Dr. Conard regarding the past and future medical care of the Rongelas 2eople. From these discussions,it has become clear that effective medical care can only be prof iced if the doctors can spend enough time with the people 09 Rongpfap t o talk to them and answer their questions. Dr. Conard ad the other doctors are making arrangements to skay on a t Rongelap for as long a s necessary t o make sure that all people geta chance to talk to thez.

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The people of Uti rik Atoll wrote a letter, dated July 1976, toMr. Roger Ray containing a series of questions about the medical program on their island.A copy of this letter is attached. The following comments concerning this letter were prepared by members of the staff of Brookhaven National Laboratory and ERDA. Following the accident i n 1954 the American physicians and scientists 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 Uti rik people would lead to diseases caused by radiation.Also,since they had shown no acute effects and only as light statistical depression of platelet counts, they were returned to their home island. However, it was 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 1975. During the past six years special at ten - tion has been paid t o thyroid examinations on an annual basis and all of the people on the island have been encouraged t o be examined and treated by the BNL physicians at sick call. Since 1973 the BNL resident physician has visited Uti rik on a quarterly basis.Dr. Kotrady was employed'by Brookhaven National Laboratory t o continue and expand the program initiated by Brookhaven and first carried out by Dr. Knudsen. I n conducting the medical examinations on the Marshallese, a comparison (control) group was selected so that the exposed and non-exposed people could be compared. This comparison group was selected in 1958 from the unexposed people of Rongelap. people from Uti rik was not considered necessary since the Rongelap group was Considered adequate for comparison with both the peoples of Rongelap and Uti rik. The slight genetic difference between the two exposed populations and differences in doses received were not considered sufficient reasons t o A Separate unexposed group of comparison

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select a separate comparison group for Uti rik. One of the questions concerned the fact that the children of the exposed islanders have not been included in the regular examination list. This was done because large groups of children of radiation-exposed parents have been studied in Japan. Since these studies, including examinations o f Marshallese . children of exposed parents, revealed no distinct genetic effects, it was felt that regular examinations of the Marshallese children born of exposed parents was not necessary. geneticists,.Dr. J; V. Neel, Professor of Human Genetics at the University of Michigan: It...there is not evidence that genetic change was induced i n children born of the exposed Marshallese any more than' there is unequivocal To quote from a letter from one of t h e foremost human evidence of damage in the children born of the exposed Japanese." 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, it would be impossible t o say itwas due to radiation. It i s most unlikely that any Marshallese child would develop such a syndrome. less, i f any child or an exposed Marshallese did,they would receive special treatment. A program for examination of all children on Uti rik is discussed later in this letter. Several of your questions suggest that the dose received by the Uti rik . people might have been higher than calculated. inthe Rongelap people, but the lack of acute symptoms and the minimal blood There were marked' early effects changes detectable only by statistical means in Uti rik individuals is cons is tent with the smaller dose of 14 rads (see Table I). I n answer t o your question about lingering radiation,it is true that there has been a small additional dose tothe people living on Uti rik and Rongelap from as light amount of fallout left on the islands. dose i s small and would not be expected t o produce any observable effects. Radiation from the fallout is getting less and less. The dose estimates

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from residual fallout is currently being reevaluated. Uti rik Rongel ap At the time of the fallout in 1954 the radiation dose tothe thyroid glands was higher than the dose to the rest of the body because of selective absorption by the thyroid of radio iodine s inhaled and ingested from contunin a ted food and water atthe time of the fallout (see Table I). The radia - tion dose tothe thyroid glands of the Uti rik people was estimated t o be about 30 rad s for adults and between 30 and 95 rad s for children compared with 335 rad s for adults and up t o 700-1400 rads for children exposed on Rongelap. By the time the people returned toUt t rik the radio iodine s had virtually disappeared so that no further significant thyroid exposure was possible to anyone living on the island since that time. There has been a false belief among the people that thyroid nodules that develop i n unexposed people living on Utirik are caused by lingering radiation. the lingering radiation is too small to produce thyroid effects. The dose from nodules occur i n people living throughout the Marshall Islands which, of course, are not due to radiation exposure. Thyroid cancer inthe exposed Uti rik people (which developed in the past few years) was unexpected. at Uti rik with the larger experience of the United States indicates that radiation very likely was involved. Accordingly Dr. Conard recommended t o the Department of Interior that all Uti rik people who have thyroid operations Statistical comparison of thyroid cancer incidence ' be considercd for compensation similarly to the Rongelap people. Compared with limited data on the unexposed Marslrallese populations there has been

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only a very slight increase,if any, i n non-cancer thyroid nodules i n the Uti rik people. The three cases of thyroid cancer in the Uti rik people compared with four in the Rongelap people is definitely higher than expected based on the estimated dose. The reason for this discrepancy i s not known. However, we have reviewed the data aild have found no reason t o change the estimates of the dose to the thyroids of the Uti rik people. The number of cases observed may vary above o r below t h e average number expected - the variation being larger as the population size decreases. In a small population such as Uti rik the difference between the predicted and observed number of cases may be substantial.Of course, thyroid cancer occurs i n populations not exposed to radiation above the natural background. The incidences of radiation induced thyroid cancer varies with different cases per million people per rad per year) varies from 0.5 t o 1.5 reported For example, in children the risk rate (in number of by the United Nations t o 5.5 fora group of Americans i n New York. It is essential to know the natural incidence inthe Marshallese and larger studies of such incidence have been initiated. Even though it 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 rosny 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 € o r developing tumors from radiation exposure been eppreeiated. Therefore, the physicians examhing you in past years, based on the best possible medical information available at that time, were justified in saying that they did not expect radiation e ffcc ts to develop i n the Uti rik people.

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At th z s t.i.)w itis impossible to predict whether more thyroid nodules will develop in the Uti rik population. importance that the regular medical examinations be continued i n the future. It is therefore of.the greatest By having regular medical examinations, signs of thyroid disease can be detected early,with prompt treatment. The medical team has been studying diabetes in the Uti rik people and other Marshallese people. Though a study of this disease was not considered a responsibility of the medical team since the disease is not related to radiation 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 to the use of Diabenase i n the treatment of this disease Dr. James Field, an expert on diabetes from the University of Pittsburgh who had been studying diabetes in the Marshall Islands with the medical team, states that " there would be inherent risks in the use of the drug. Diabenase in treating diabetes on Uti rik or other outer islands in the Marshalls 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 a s being responsible for a reduction in size of arrowroot o r of any other plants growing on Utirik …