The DOE Medical Program in the Marshall Islands

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THE DOE MEDICAL PROGRAM I N THE MARSHALL ISLANDS Following the accidental exposure to radioactive fallout (March 1, 1954) of 244Marshall Islanders and 28 American servicemen,the AEC (now DOE) initiated a regular medical examination and treatment program for radiation effects in the exposed Marshallese which has been under the direction of Brookhaven National Laboratory since 1956. The examinations have been carried out with the cooperation and participation of medical personnel from the Trust Territory. The examinations have been on an annual basis for the Rongelap people and every three years for the Uti rik people until six years ago when all of the people have been examined annually and, in addition,quarterly medical visits to Rongelap and Uti rik have been made whenever possible by a Resident Physician A group of 150 unexposed Marshallese serve as a control group and are examined the same as the exposed groups. The medical findings are summarized below in section I and in section I1 are outlined the various measures taken by AEC/DOE to aid the exposed people. I. Summary of medical findings and treatment_: The fallout accident in 1954 resulted in exposure of the Marshallese on Rongelap, Ailing nae and Uti rik atolls to fallout radiation before they were evacuated by about2days. Whole-body exposure from penetrating gamma radiation gave an estimated175rad s to the 64 people living on Rongelap, 69 rad s to the 18 people on Ailing nae(these were Rongelap people on a fishing trip to this nearby atoll during the fallout) and 14rad s to 157 people living on Uti rik atoll.In addition,there was internal absorption of radio nuclides from i n - hal ation and ingestion of contaminated food and water and fallout deposited on the body caused significant skin exposure in the Rongelap and Ailing nae groups The radiation to the skin was spotty and superficial and the dose, though indeterminate,was probably greater than 1000 rads. Except for radioisotopes of Iodine,the radio nuclides absorbed from the fallout are not believed to have resulted insignificant internal exposure. The magnitude of the dose to the thyroid glands from radioactive iodine s was not aT pre cia ted until later when thyroid nodules unexpectedly developed and reevaluation of the dose showed that the early estimates had to be revised upward, particularly in the children. (It was estimated adults on Rongelap had total thyroid doses of 335 rads and young children 700-1400 rads.) The Rongelap and Ailing nae people were the only ones to develop acute effects of exposure(transient nausea and vomiting,he mop oie tic depression and widespread be task in burns and e pila tion,but with no detect i ble acute effects related to internal absorption of radio nuclides). The low dose Uti rik group showed only statistically as light depression in platelets without clinical signs of exposure.There were no deaths associated with the acute exposure of the Marshallese and,except for the skin burns, no treatment was necessary. Blood levels returned to near normal by one year and beta burns healed and hair regrew within a year with only a mild scarring and res i du a in about15

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During the ensuing decade the people remained as healthy as the population of unexposed Rongelap people used as a control group (about 200) with no further evidence of radiation effects,except an increase in miscarriages and stillbirths in exposed women which is questionably related to exposure. A. Studies with negative findings Animal studies have shown some non specific late effects such as accelerated aging and premature deaths from degenerative diseases. Such effects have not been detected in human exposures.Radiation - induced shortening of lifespan appears to be related entirely in human beings to certain malignancies.In the Marshallese numerous studies of premature aging effects,similar to those carried out in the Japanese, have not reve a led evidence for such effects.There has been no indication thus far of any increase in degenerative diseases among the exposed Marshallese or Japanese.Similarly, though genetic defects in offspring of irradiated animals have been demonstrated,such defects have not been positively identified in studies of the first generation children of the Japanese. I n view of the negative nature of the Japanese findings no organized genetic studies of the Marshallese children have been carried out, though no apparent effects have been noted in the newborn, most of whom have been examined. number of blood samples of children of exposed Marshallese for variants of serum proteins and erythrocyte enzymes that might indicate genetic mutations. B.Possible radiation late effects in the exposed Marshallese (a) Growth retardation, development of nodules Between 5-10 years after exposure growth retardation in several of the children exposed a t less than5years of age(particularly notable in two boys exposed at1year of age)was the first evidence of thyroid injury. Thyroid nodular it y first began to appear at9years after exposure in the Rongelap people and shortly thereafter in the Ailing nae group and more recently in the Uti rik population. shows the present status of the thyroid findings,including the results of among the 244 exposed Marshallese (39% of the Rongelap people and 7.0% of the Uti rik people compared with about 5% i n unexposed Marshallese). The occurrence of three thyroid cancers in the exposed Uti rik population (compared with four in the Rongelap group) appears to implicate radiation exposure in the etiology but the high incidence is puzzling since it i s greater than would be predicted based on Rongelap and Japanese data, and there does not appear to be any increase in benign thyroid tumors inthe group compared tothe much greater pre valance in the Rongelap group. The accompanying table The institution of hormone treatment(Synth roid)inall exposed Rongelap people, which began i n 1965, has been essential in maintaining a eu thyroid state in the operated cases and has been important in correcting growth

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retardation in the children. However, the continued development of thyroid nodular i ties causes us to question the efficacy of the treatment in preventing the development of such nodular i ties.Several years ago the Ailing nae group were also included in the treatment program. (b) Development of hypothyroidism During the past several years,with the development of more tests)extensive examinations of the exposed Rongelap people have indicated that some o f them without thyroid nodules are developing hypo thyroid is m. There are atleast4people definitely in this category,but there are 6-8 more who have suggestive findings in this regard. 2 . Leukemia and other malign an cie sY I n 1972 a young, exposed Rongelap man died of acute myelogenous leukemia. One death also occurred in an exposed Rongelap man due to cancer ofthe stomach. These are the only two deaths in the exposed Marshallese that may be related to radiation exposure. Middle-age onset diabetes is very common in the Marshallese and presents a very serious problem. The BNL medical team has been studying this disease in order to advise the Trust Territory concerning the best treatment.Intestinal parasitism is prevalent throughout the islands and a n evaluation and successful treatment program has been instituted for Rongelap and Uti rik Atolls. Many other diseases are also treated by the doctors on their visits to the Islands. D.Radiological monitoring of personnel Continued evaluation of body burdens of personnel living on Rongelap and of personnel and by radio chemical urinalysis. below the established maximum permissible levels and the slight exposure received by the people is believed to be far below levels that would produce detectable were carried out by gamma spectrograph ic analysis (whole body counting) Body burdens have been well 111. Measures by AEC/DOE toAid Exposed People of Rongelap and Uti rik 1. Annual medical examinations - with donation of time and effort by medical specialists from the U.S. 2. Past6years establishment of Resident Physician in the Islands and recently a Marshallese nurse. 3 . Expanded healthcare program since1972, examining everyone on Rongelap and Uti rik(including children) and supplemented with quarterly

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visits by the Resident Physician. Treatment has been given when possible on the Islands or referred to medical centers. 4.Special examinations and treatment for possible radiation effects in U.S. Thyroid cases studied at BNL with surgery at either Boston or Cleveland (38 cases). Leukemia case t o BNL and NCI. 5. At time of surveys donations of eyeglasses for reading ; drugs for dispensary.Also gift food to Islands to last several days. 1. Remuneration for loss of personal effects and livestock t o Rongelap and Uti rik people. 2. Built temporary village at Majuro for Rongelap people with subsidization until return to Rongelap Island. 1957 Built new village at Rongelap. Partial food subsidization 1965 % $11,000 compensation to each exposed Rongelap person. 1. CI, $18,000 " inconvenience payment" to Uti rik people. 2 . DOE/TT agreement t o pay $20,000 annually in support of PL-5-52 to help pay for cost of transportation and hospi - t aliz ation of Rongelap and Uti rik people on the BNL 1. $25,000 compensation € or thyroid surgical and other cases i n exposed Rongelap and Uti rik people. 2. New agreement pending for DOE support of revised PL-5-52.

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Th )id Lesions in Marshallese, Ma: 1978 Age a t Est. thyroid%Subjects b with No.subjects%Subjects b with Group exposure do sea,rad s thyroid lesions with surgery malignant lesion Rong. + Ail. + Uti rik All 30-1150 18.4 (45/244) 34 2.9 (7/244) Uti ril c unexposed < 1 0 Li ki ep unexposed < 100.0 (0/43) 0 a Dose from l3I1, 1321,1331a n d I35J plus gamma; mean dose extrapolated from calculations adults and 3-year olds. R; o n niirnber of people exposed, excluding those in utero (numher of cases / total number i n The thyroid is considered to hc fully developed hy about age 18. dOnc. additional case o f adcriorris, found at autopsy,not included here. iT d eight ed mean dose.