Dose of Radiation Received by People of Utirik and Rongelap (Partial)

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in~rolved, based 011 lcrrordedge of human radiation effzcts available at that time, dTd not believe that the dose est in a ted to Si?t'e besn received by706343 the Iitiril: people would lead to diseases czusecl 5y radiation, Also, shce they hzd shown us 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 Utirik people should b e exmined at regular intervals and they were given complete physical es&ations i n 1957, 1959, 1963, 1966; 1969, 1972 and 1975. During the past six yeais special attention has beelz paid t o thyroid exaninations on aa annual b a s i s and all of the people on the island have been encouraged t o be exd ned and treated'by the physicians at sick call. Since 1973 the resident physician has visited Utirik on a quarterly basis. Dr. Kotrady was employed by Erookhavett Bationa1 LaSoratory t o continue and expznd the progrm in it iz ted by Broddmven and first carried out by Dr. Knudsen. There were different return times f o r the Utirik people end the Eo~)-cl.:~p people from Kwajalein (foXl.orri,ng their evacuation) i n 1%4---thc :)eaLG-c of Uti rir : rzrlxmned t o t!ieir atoll after three months, and the peoplci 03 Eongelcp returned to their atoll after threo pars, ! tloulcl it be correct to say that perhaps the Uti ri Ic people receivsc! kore than orly 14 rads i n light of their quick return time to Utirik? Although the estimated doses received by both Rongelap and U t i x i k people are inexact, a review of the datr? - indicates that the dose estimates are reasonable estimates. There were mer%ed early e ffcc ts in the Rongelap people, but the lack of acute symptoms and the minimal blood changes dctcctabfe by statistical means i n Utirik in divi duds is consist cnt with a small dose. to their home island sever21 months d ker the fa:lout would,have contributed only a very slight increase i n dose since surveys of the island revealed that the rzdiaThe fact that the Wtirik peqle were return-ed tion levels were vepj low.

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in Uti rik and a lot in Rongelq? of rit dig nmt thyroid gl,mds in Uti ri ! c as GherG are in i long ol q ? The doctors from 3ih.A have told us that there vere 14 rzds i n titi&; u1c! 175 rads i n itongelap, therefore, ue are very surprizcd, beczuse in Gti rS : have ten cases of thpid nodules, three of which re m&gnaRt. they have thirty cases of th poi d nodules, and also thr se cases of rndZpm,c;r., Perhzps you can t e l l us if there is some eqlanation for the sate nmber of ?I~~.:~II,v.s ,.thyroid cases i n Rongelap and Utirik, rrho rcceived wry clifferent levels or" The ra diz tion dose tothe thyroid glands was higher than the dose t o the rcsi: of^ the body because of selective absorptiori 37 the thyroid of radioiodines inhaled and ingested from contain ate6 food and water zt the time of the fallout. Ut frik people 1.7as estimated t o be about 30 rads for z du lts 2116 S==veen 30 2nd 90 rads f o r chtldren compared with 335 rads for adults m d up t o 700 - 1400 rad s for children exposed on Rongelap. The radiation dose tothe thyroiC glads of the By the tiscz t h e people I returned to Uti rik the radioiodines had virtually dT s qp are2 s3 that no further significant thyroid esposure was possible to a yone living on the island at that the. "he development of thyroid cancer in the Uti rik people within the past few years was unexpected. Statistical comparison 04 thj-roid cancer incidence at Uti rik with the laxger experience of the United States indicates that radiation very likely was involved. Accordingly it was rec mended tothe Department of Interior that all Uti rik people :.:i70 have thyroid operations be considered for corrpensation similarly to the Rongelap pesple, Comparec! with lCTiiitcd data on the unexposed Y-Iarshallese pop ul a tio is there hr?s bcen onlya very slight increase, i f any, i n nofi-c2ilcer thyroid nodulcs in the Uti rik people. The thrce cascs of thyroid ' cancer In the Ct irt k

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people compared with four in the Rongelap people i s de. expscted based on the es tim ted dose, sad lime found R O reason t o change the estimates of t5.- dose to the t5y roid s of t h e Utirilc people. the average nwqber expected - the variation being larger as the population t h e predicted and observed nmboer of cases may be substsntial. tliyroic? cancer occurs i n populations not exposed to radi at i or ! above the itely higher than However, we ha72 revieved t h e data The imnber of uses observed zzj - vary ebove o r below natural background. The incidences of thyroid cancer varies with different population groups. For exzaple, i n children the risk rate(in nmber of cases per million people per rad per year) varies frm 0.5 to 1.5 reported by the gnited Nations t o 5.5 for a group of Americans i n Hew York, It i s . essential t o know the natural incidence inthe Marshallese a d larger stud les of swh incidence have been initiated. Even though i t was kno m that the dose t o the thyroid glads was higher than tothe rest oE the body, what w2s not known during the earlier years was the degree of sensitivity of the thyroid gland to radi at ioa, Even toda7, there are many facts about radiation that are not knovn, despite the large number of scientists that have studied this subject for the pest twsnty or thirty years. Even less was known about radiation in 1954 at the the of the exposure tothe people on Rongelep and Utirik. has ths degrea of sensitivity of the thyroid for developing tmors from radiation exposure been appreciated. Tlicreforc, the physicians ex a in ing you in past years, based o:! the best possible medical fnfornation zvaflable at that time, were beirig truth Ed when they said that they did not ergecl: radiation effects to develop i n the Uti rik people.

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trould it be correct t o say that rre c m exoect ~ianymore case: will develop i n the L!t.irik pcpulation. It i s therer'ore of the greatest: importance that the regular ne dic alex mi nations ti ccntiimed. in the future. By hnving regular med kal exaxinations, signs of thyroid Giszase can be detected early, and prom?t treatmen;: will avoid ume ces s aq suffering on a) The peop2.e of Utifik are diffemnt from t h e people of Rongelap--the:r b) The people of Uti rik trsre exposed t o different levels of radizt€on + ,ha rads, and Rongelap he4 175 rads, ' are a different gene pool and breeding po?ulation, In cond x ting tSe medical ex mi nations on th2 Ilarshallesz, n conperison I be conpared. lhis ccnparison group was selected in 1955 fro-i the unexposed people of Rorigelap. people from Utir'ik was not coasidered necessary since t h e Rongelap group A separate unexposed group of comp?rison was considered adequate for coEparlson vith both thc peoples of Zoongelap 2nd Uti rik. The slight genetic difference between the tno exposed populations and differences in doses received T-iere not considered suff2cient reasons to select a separate comparison group for Utirik.

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ODe of the questions concerned the fact that the children of the exposed islanders have not been included in there g elz r examination list, This was done. because l a r g e groups of children of radiation-exposed parents of 1-12rshallese children of exposed parents, revezled no distinct genetic effects, it tias 2 of the foremost felt that regular examinations of the f4arshallese children parents was not necessary. University of Michigan: ".., there is no evidence that genetic change was induced i n children born of the e qo sed Efaxhallese any more than there is unequivocal evidence of danzga i n the children born of the exposed Japanese." H e pointed out, howl-ver, that there are some 15-20 dominantly inherited syndromes that might possibly be related to rz di ation exposure. Even i f one of these occurred, it would be k.possib leto say i t was due t o radiation. child would develop such a syndrome. It i s most c-nlikely that any Marshallese Nevertheless, if my child of an exposed Marshallese did, they would receive special treztnent. A program for examination of all children on Uti rik is discuss dle ter in this.letter.

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Yne niedical tea- has been stuclylng diabetes i ~ -ths U t l r i k people and a responsibility of the rredical teai since the dlsease is not relzted to radiation exposure, it WRS considered iinportznt to help the Trust Territory with this disease which i s such a serious problez i n the Pfarshall Islands. W.th regard tothe use of Diabenase in the trekk?xt of this disease Dr. James Field, an ex2ert on diabetes from the University of Pittsburgh who hail been studying dicbetes i n the PIarshall IslznCs vith the medical teiim, states that "there would b e inherent risks i n the use of the drug D-iabenase in treating diabetes on L'tirik o r other outer islsrrds in theMarshalls since Ziough a study of this dfsease ~ ~ 2 snot considired long tern medical supervision and laboratory tests 2re necessary to insure its safe and effective use." At present the arm:rrmt s t d h ne;LSme o mresult of the radiation, foot, vhcrezs before the rackicrtion they measured Zivc feet, With regard t o your coment about the reduced size of arr mio ot plants on Uti rik, we caa state that the results of studies of radiation effects on plants would not support radiation exposure a s being responsible fora reduction in size OE arrowroot o r of any other plat s growing on Utirik Atoll. Numeroxs studies of radiation on Uti rik show thc 1eveI.s have been too 1oi3 to rcsult in such effects.

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IJe believe D r s . Conard, Kotrady, and Knudsen to be very cap?.ble and conscientious physicians who art? deeply comitted to the health m d welfare of the people of Uti rik. Noreover, the report by the Spec i dC mitte e on Rongelap add U t i r i k , v-hich was former! by the Congress 3E Xcronesia, vas favorable with regard to the examinations, In viev of thz & we,we x.:ere greatly surprised to learn about the apparent displeaszre C;I the part of the people of IJtirik as e-xpessed in yocr letter. as eqr-zssed in your letter, could possibly b e am.ls1xdzrstra8iog cs to their role zr.6 reasons t o coize t o the is lz nds.I would like to repeat that itis my fin conviction that the principal concern of Drs. Comrd and Kr-dsen i s the ~ te liar eand well-being of the Uti rik people. il rnisundzrstcmding could c icily result f rcxn the dLffererrse im 1angua%e, Again, I . ; auld appeal to the Chiefs of Uti rik to L q res s c2on tb-eir people the inportance of the medical exminations and ths cecessrcy to trust and cooperate with the Amerlcan physicians. It i s posslb3.c that such

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First it should be, said that t i r e kizs been continued Essasszseat of the tests have been and are being z d s on soil, plants, water asd on persozs .living on the islands by measurezent of rsdiation checks of urine. low as notto present a serious threat to their health. an areal survey for radiztioc i? tte northern Ekrshalls 2 s pl;ll~?edwhich should give better infoncation on t h e outlying islacds of K.be ,=tolls. A toxic Energy Agency t o carry out zn independent eva lm tio a of the r do logic el situation on these islands at the time of this survey. With regard t o education of t h e people on t3ese islaEds about r&etion zkf the islands of Rongelap and Utirfk for several weeks on each atall m d c a r f y oat an educatiorisl progrvn on this s u 5 j e c t using illustrzted lectures asd d~?zon- . The resclts indicate that the levels of e qo sure zre so W e would like to info m the Uti rik people that we at ici pate introducicg Mlcini. and Eniwetok. the physicians of ever;ow living on Uti rik island, inc?udlr.g ~ lnes ~ osed people a d children, It should 'se pointed out t h t orly the eqosec! Utirik ;eo?le are s lig i ble for the ce-ifits of ?L 552, AS in the past eveZ7one tit P-Lfrik vlo.lld Such a prog rm vould include annuzl zx a i nations by hzve the opportunity t o be see:! zt sick call during the qm te rly visits of the Resident Physician. / This meeting is baing held to disc ws these ?laas which we hope will provide a basis for bst ter health care for tie people of Utirik er.d .