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The people of Rongelap Atoll wrote a letter, clar~i (lccober, 1976, about the medical program on their islr.nd. A cop)’ of :Ilis letter is attac!led. Erookhaven NatioIlal Laboratory and ERDA. The first comment is with regard to travel of }farshzllsse patients to the United States. Since only very few Americans know che !iarshallesc langua~e, it is indeed necessary to accompany patients chat coxe tg the U.S. for trea~rnent by Marshallese attendants. Unfortunately-, on or about two occasions, this did not occur for various reasons. Every effort will be made in the future to have all parients accompzfiied by Zn:lish-speaking Marshallese attendants. Also when traveling outside Lhe Trust Territory, they will be provided with adequa~e traveling funds. Ia zddition, the Trust port: well. in advance. Whenever the Brookhaven doctors arc at Rongelap, they give arnyone with sickness the best treatment available under the circumstances. A.s in the tion exposure will be Calcen to Lhe U.S. for treatment if neccss2ry. In the case that adequate facilities are available locally, patients that require hospitalization will be treated in the Trust Territory hospitals. Dr. Knudsen will assis~ in the trcatnlent of the patients at these hospitals. klcc~icincs needed for treatment at llon~elap that are not available from the ‘Jkust Territory Department of Ilealth Services will, i.f possible, be proviclccl by ERDA doctors,
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are low and they are getting less and less. lle littls hit of rzdiztion left on the island would not be expected to cause any >zzlt’n effects. (<e are pleased that Dr. Naidu was able to visit you and ez~lzia zbout raclizti.on and its effects. We hope to have other scientists, ?ossibly some from other countries, visit Rongelap in the future to continue this educaAt the time of the fallout in 1954 the rzdiatioa 20S? to the thyroid glands was higher than-the close to the rest of the bodj- ‘o~czuse of selective absorption by the thyroid of radioiodines inhalecl and ~~~~ested iron contaminated fcod and water at the time of the fallout (see i~ble 1). The rzdiation dose t’o the thyroid glands of the Rongelap people WES estiaated to be about 335 racls for adults and up to 700-1400 rzds for ch~ldren. Ey the time the people returned to Rongelap the radioiodines ‘nad virtually disappeared so that no fu~-ther significant thyroicl ex-posuza W2S possible to anyone living on the island since that time. There has been a false belief among the people that thyroid nodules that develop in mewosed people living on Rongelap are caused by lingering radiation. ‘he close frcm the lingering radiation is too small to produce thyroid effects. Th>_roid nodules occur in people livin~ throughout tl}e}Iarshall Islands wl]ich are, of course, not: due to raclia~ion exposure.
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\Je are pleased about the reina~-ksm~c!e in your letzzr :.bout the Brookhaven medical team. EFOA has a great deal of confidence in 3US. Cc~azrd :.nd Knudsen and the other fine doctors that have taken part in the ne<ical ?rogr~~. We are sure ~hey always had your wel.iare at heart. ~~e are convinced thot the medical exaiiinations of t!l? RonSe12p people have been very thorough and complete with macy tests on the p2021e md on their blood, urine, etc. Some of the most skillful doctors in the U.S. and from other countries have taken part in these ex.aminztians. ‘Ih2y have used the best equipment possible t-hat can be taken to the island. You CPQ be sure that the examination program ensures early diagnosis and Ereatnent of Currently, arrangements are being discussed to ~z~~it 211 the people living on Rongelap, including children, to have an exz2i.n2tioo 2t least once a year by the Brookhaven doctors. We have plans with tie Trust Territory to provide further education for the Ilealth Aides in the diagnosis and treatment of radiation effects. v]e realize that at the time of the annual exa:ninations, there is sufficient disruption of life and that the team sl]ould provide additional food. Tllcrefore a sufficient amount of food will be furnished by the tea duri~~g t-he period of the examination. gardi.nz the past and future medical care of the Rongelap people. From these discussions, it has bccomc clear that effccti.ve mediczl. care can only be profited if tllc doctors can spend cnoLlgh time wit_h ti~e people of Rongelap to are making arrangements to stay on at Ron~c12p f’or as 10P.3 as necessary to m,nke sure that all pcop].c get a chnncc to Ialk to Ltlen.
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The people of Utirik J.toll wrote a letter, dated .Tuly 1976, to Fir. Ro~el- Wy containing a series of cluestj.omsr.bout the riedi.calpro~ram on their island. A copy of this letter is attached. The followins comments concerning this letter were prepared bY members of the staff of Brookhaven National Laboratory and ERDA. Following the accident in 1954 the America physicians and scientists involved, based on knowledge of human radiation effects available at that time, did not believe tl~at the dose estimated to have been received by tile Utirik people woul_d lead t-o cliseases caused by raciiation. Also, since they had shown no acute effects and only a slight statistical depression of platelet counts, they were returned was considered prudent that the Utirik intervals and they were given complete to their home island. However, it people should be examined at regular physical examinations in 1957, 1959, 1963, 1966, 1969, 1972 and 1975. I)urinE the past six years special. attention has been paid to tllyroi.dexcminatirrns on an annual basis and all. of the people on the island have been encouraged to be examined and treated by the BNL physicians at sick call.. Since 1973 the BNL resident physician has visited Utirilc on a quartcl-ly basis. Dr. Kot_raclywas employed by LJrookhavcn National. Laboratory to continue and expand the proEram i.nitiatcd by Brookhaven and first carried out by Dr. Knudsen. In conducting the medics 1 examinations on the Marshall.cse, a comparison (COIIEI-O1)~roup was selected so that the exposed anct non-exposed people could be comparccl. Illis comparison Sro(lp \Jas selected in 1.958 from the unexposed people of Rongelap. A Separate unexposed group of comparison people from Utirik was not cons i.dcrcd neccss al-y since the ~ton~cl.apL1-oup
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select a separate comparison group for Utirik. One of the questions concerned the fact that the chilclre.nof the exposed islanders have not been included clone because large groups of chi studied in Japan. Since these s in the regul.~r examination list. ‘fhis was children of exposed parents, revealccl no distinct genetic effects, it was felt that regular examinations of the Ilarsha].lese children born of exposed parents was not necessary. To quote from a letter from one of the foremost human of Michigan: ‘l... there is not eviclence that genetic change was induced in chi].clrenborn of the exposed Marshallese any more than there is unequivocal evidence of cl.amagein the children born of the exposed Japanese.l’ ?ie pointed out, however, that there are some 15-20 dominantly inheri-tecl syndromes that might possibly be related to radiation exposure. Even if one of these occurred ~ it woL1l.clbe impossible to say it was clue to radiation. It is most unlilcely that any Marshallese child would develop SUC1l a syndrome. Nevertheless, if any child or an exposed hfarsl~allcse did, they would receive special treatment. A prozram for exwnina~ion of all children on Utirilc is discussed later in this letter. Several of your questions suggest that the close received by the Utiri.k people mighi have been higher than calculatccf. ‘IIliicwer~ markecl’eirl.y effects in the Rongelap people, but the lack of acute symptoms and the minimal blood In answer to your clucstion about li.nr,crinf; radi.<ation, it is true that aclditi.onal dose to the people livi~lg on Utirilc and
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from rcsiclual fallout is cL1rrenLly being reevaluated. At the time Of the fallout in 1954 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 radioiodines inhaled and ingested from contaminated food and water at the time of the fallout (see Table I). The radiation dose to the thyroid glands of the Utirik people was estimated to be about 30 rads for adults and between 30 and 95 rads for children compared with 335 rads for adults and up to 700-1400 rzds for children exposecl on Rongelap. By the time the people returned to Utiri.k the rzdioioclincs had virtually disappeared so that no further significant thyroid ex~osure was possible to anyone living on the island since that time. T!lere 110s been a false belief among the people that thyroid nodules that develop in unexposed the lingcrinz radiation is too small to produce thyroicl effects. Thyroid nodules occur in peep].c living throu&hout the llarshall Islands which, of course, are not due to ~-adiation exposure. Thyroid cancer in t!le exposed Utirik people (which developed in the past few years) was unsxpcc[:cci. Statistical. comparison of thyroicl cancer incidence at tJLirik with the l.ar~cr experience of Llle United States indi.cat-es that
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only a very slight increase, if zny, i.n non-cancer thyroid nodules in the ULirik people. llle three cases of thyroid cancer in the Utirik people compared with four in the Rongelap people is definitely higher than expected based on the estimated close. ‘he reason for this discrepancy is not known. However, we have revier;ed the data znd have found no reason to change the estimates of the dose to the thyroids of the Utirik people. The number of cases observed may vary above or below the average number expected - the variation being larger as the population size decreases. In a small population sLlch as Utirik the difference between the predicted and observed number of cases may be substantial. Of course, thyroid cancer occurs in populations not exposed to radi.ati.on zbove the natural background. The inc.idences of radiation i.nclucedLhyroid czncer varies with different population groups. For example, i.n children the risk rate (in number of cases per million people per rad pcr year) varies from 0.5 to 1.5 reported by the United Nations to .5.5 for a group of Americans in New York. It is essential to kno~.7the natural incidcncc in tilepfarshallese and larzer stL1di.cs of such incidence have hcen i.ni.tiated. Even though it was known that the dose LO the thyroid glands was higher than to the rest of the body, what was not known during tl~c earlier years was the dc~ree of sensitivity of the thyroid gland to radiation. Even toclay, 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 or thirty years. Even less was known about radiation in ~g54 at the time of the exposure to Llle people on Rongclap ond Utirik. Only rc].ati.vely reccntl.y Ilas the degree of sensitivity of the thyroid for dcvclopins Lumors from radiation exposure been apprc:ciated. ‘Therefore, Lhe physicians examining t i.mc, (]erc justified in sayjng Lllat Elley clid IIOL expect r,?cliati. on
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At this t~)I> it is impossible Lo prcclict Whethel- more thyroid noclulcs will clevelop in the ULirik population. IL is therefore of the greatest importance that the regular medical. examinations be continued in the future. detected early, with prompt treatment. The medical team has been studying diabetes in the Utirik people and other lfarshallese 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 is such a serious problem in the Pfarshall Islands. With regard to the use-of ~iabenase in the treatment of this disease Dr. James rielcl, an expert on diabetes from the University of Pittsburgh who had been studying diabetes team, states that “tl~cre would in treating diabetes the Marshall Islands with the meclical. inherent risks in the use of the drug supervision ancl laboratory tests are to insure its safe and e.ffcctive use.” re~ard to your comment about tF,e reduced size of arrowroot plants T7C can state that the results of studies of radiation effects on planLs would not suppor~ raciiation exposure as being responsible for a reCIUCtiOIl in size of arrowroot or of any other plants Growing on Uti.rik Ate].].. Numerous studies of radiation on Utirilc show the levels have been too low to We believe Drs, Conard, Kotrocly, and Knuclscllto be very capab].e and
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favorable v;ith rcgcrd to the examinations. In view of the above, we were greatly surprised to learn abotlt the apparent displeasure on the part of the people of UEirik as expressed in your l.c:tter. One possible explanation for this difference in senti.melltwith regard to Drs. Cons.rd and Knudsen, as expressed i.n your letter, could possibly be a misunderstancli.ns as to their role and reasons to come to the islands, I WOLlld like to repeat that it is my firm conviction that the principal concern of Drs. Conard and Knudsen is the welfare and well-being of the Utirik people. It i.s possible that such a misunderstanding could easily result from the difference in langua~e. appeal to the Cl~iefs of Utiri.k to impress upon their people of the ‘medical examinations and the necessity to trust and tile American physicians, We would like to inform the ULirik people that ERDA is cooperating with the Tmst Territory in an expanded l~eal.thcare prograrm for people living on Utirik and Rongelap. Such a program would include annual examinations by the physi.ci.ans of everyone livinz on Utirilc island, including unexposed people and children, ,ai]dthe opportunity to be seen at sic-k call durin~ the quarterly vi.si.tsof the physician. The people would then have the assurance that all of them are cnti’cleclto be part of the ex~amination program. ml c exposed Rongel.ap ancl Utirik people ~nd the unexposed Rongelap conLrol. group, as in the past, would recei.vc special examinations for radj.ation effects ancl this group (which does not include chil.clrcnof exposed or other unexposed