Field Task Proposal/Agreement, Subject: Medical Studies of the People of the Marshall Islands Accidentally Exposed

Page 1

FIELD TASK PROPOSALIAGREEMENT ( 1. WORK PACKAGE NUMBER 2. TASK NO. 3. ;E. 4. PROJECTNO. 5. OATE PREPARED 6. CONTRACTOR NUMBER the Marshall Islands Accidentall~ Exposed. 15. WORK LOCATION (.% ;n$tmct:M$l: N~e of facilirv. Cirv,Stefe,ZipCode 16. I$thls task 17. Does this task Include included in the any management 18, TASK DESCR IPT; ON (Appr&ch, raleriorr to twrk package, in 200 words or less) The primary objective is the determination of the life–time effects of fallout radiation on the Marshallese who were accidentally exposed to radioactive fallout on March 1, 1954. Medical Surveys of these people have been conducted at quarterly intervals, and an unexposed Rongelap population is examined for comparison. The surveys, carried out jointly by Brookhaven National Laboratory under the auspices of the Department of Energy, and the Trust Territory of the Pzcific Islands, are of great importance in view of the development in this population of growth impairment in some exposed children, thyroid lesions, and one case of acute leukemia. 19. CONTRACTOFI TASK MANAGER Environmental Assessment al, OtMr(SXClfY):

Page 2

TASK REQUIREMENTS FOR OPERATING/EQUIPMENT Associated Universities, Inc. c TOTAL DIR EAT,..... ... Consmnt BY dollars

Page 3

TITLE Human Health Effects from Energy BUDGET AND REPORTING CODE DATE PREPARED Generation: Medical Studies of the HA-02-01-01 03131/80 People of the Marshall Islands CONTRACTOR NAME CODE WP NUMBER TASK NO. REV. NO. Associated Universities, Inc. BNL o It is anticipated that work for this proposal will use existing Laboratory facilities and site utility services. In addition a doctor’s office and laboratory has been established on Kwajalein and Ebeye Islands in the Marshall Islands and shipboard support for the medical teams will be required as they visit the outlying islands. The ship provided for the previous year has proven to be inadequate for medical purposes and active consideration is being given to the procurement of a different vessel. The currently used ship is 115’ long and is prohibited from “carrying passengers”, however when a field survey is conducted up to 35 passengers including patients and medical personnel may have to be carried. Consultationswith shipping experts have indicated that a ship of approximately 185’ in length would provide adequate living space for a party of this size. In addition, the ship requires a double (parallel) multiphasic screening examination facility for male and female patients, laboratory space and x-ray area. Ac ti.ve negotiations are underway with the Department of Energy to provide such a vessel. None in FY 1979. In FY i980, the 25th year Report now in preparation will be published as well as the 26th year Annual Report. Post-exposure surveys in the Marshall Islands have been conducted for 25 years . In addition to the 244 persons originally exposed, a group of unexposed Marshallese are examined for a “comparison population” to assess late effects of radiation from fallout. The continuing development of thyroid neoplasms, biochemical hypothyroidism and the appearance of one case of acute leukemia, indicate the need for frequent examinations . In addition to routine physical, hematological, and other laboratory examinations, the surveys involve special studies related to aging, malignancy, reproduction, and measurement of body burdens of radionuclides resulting from the slight contamination remaining on the islands. Patients with thyroid nodules are returned to the United States for complete hospitalization and surgical treatment as indicated. In view of the diverse medical problems and their management, a physician, a Marshallese nurse-practitioner, and a laboratory technician are in residence at Kwajalein and make regular trips to Rongelap, kiajuro, and Utirik to supervise care and perform interim examinations of the The R&D work contemplated shall be conducted in conformance with generally accepted methodology for scientific investigations of this character, as practiced at universities and large independent laboratories including Brookhaven National

Page 4

TITLE Human Health Effects from Energy BUDGET AND REPORTING CODE DATE PREPAREtI Generation: Medical Studies of the HA-02-01-01 03/31]80 People of the Marshall Islands A ccidentallv 12fDo sed to Fallout CONTRACTOR NAME CODE WP NUMBER TASK NO. REV. NO, Associated Universities, Inc. BNL o Fiscal control will be exercised in the form of monthly comparison of actual costs incurred against corresponding line items in the budget. Substantive progress shall be monitored through a periodic review of accomplishments conducted by the Contract Task Manager. In response to requests by the people of Rongelap and Utirik, the Department of Energy agreed in February 1977 to assist the Trust Territory in an expanded health care program for the people living at Rongelap and Utirik Atolls. Accordingly, during the January - February 1979 survey (25 years post-exposure), all Marshallese living on these atolls, who wished it, were given complete medical and laboratory examinations similar to those in the exposed group. Greater physician-patient relationship was attained by lengthening the stay on the islands, which necessitated doubling the size of the medical team by releasing one team after 2 l/2 weeks to return to the United States and utilizing a second team for the second half of the survey. A 2nd survey covering 4 weeks in May and June concentrated primarily on pediatric evaluations and sick call plus a reevaluation of those thyroid nodules found on previous surveys. On the final three days of that survey Dr. Brown Dobyns, thyroid surgeon, flew out to Kwajalein and the entire team evaluated the 14 prospective surgical candidates. All were cleared for transfer to Brookhaven National Laboratory for medical evaluation and then on to Cleveland Western Reserve for definitive surgery. The group was divided into nine patients who underwent surgery in early July, and a group of five who underwent surgery in September. A third survey was conducted in September and October covering a five week period. This survey was directed towards the treatment of dental and ophthalmologic problems and the treatment of intestinal parasites on the major islands. Thyroid abnormalities continue to be the only definitive findings related to radiation exposure. During the past year, thyroid surgery was done on seven of the exposed group and five of the unexposed comparison group. In addition, surgery was performed on two Marshallese from Wotje Atoll who were not in the long term study groups; one of these lesions turned out to be a carcinoma. There have now been 48 thyroid abnormalities (41 with surgery) among the 246 exposed ~larshallese (4i% of the Rongelap people and 8% of the Utirik people). The occurrence of three thyroid cancers in the exposed Utirik population (compared with four in the Rongelap group) appears to indicate radiation exposure in the etiology, but the high incidence is puzzling since it is greater than would be predicted based on Rongelap and Japanese data and there does not appear to have been any increase in benign thyroid tumors in the Utirik group compared to the greater prevalence in the Rongelap group. Because of the uncertainty of the incidence of thyroid tumors in unexposed Marshall Islanders and in order to obtain better statistics, thyroid examinations were included for all unexposed Rongelap and Utirik people on any of the Marshall Islands visited. This study has been extended to- include thyroid surgery when indicated. Also, in order to help solve

Page 5

TITLE Human Health Effects from Energy BUDGET AND REPORTING CODE DATE PREPARED Generation: Medical Studies of the HA-02.-O1-O1 03/31/80 People of the Marshall Islands CONTRACTOR NAME CODE WP NUMBER TASK NO. REV. NO. Associated Universities, Inc. BNL o 2cf. Technical Progress cont. Technical Progress in BY-3 (FY 1979) cont. the Utirik dilemma, reevaluation of radiation doses from fallout to the Utirik people, including the thyroid, is in progress. The bill authorizing compensation to certain of the Rongelap and Utirik people for radiation injuries was signed by the President and payments were completed during FY 1979. A study of diabetes, a serious disease in the Marshall Islands, was initiated several years ago and the data collection has just been completed. A report of the results of this study will be issued shortly. During this fiscal year an intestinal parasite survey was completed on Rongelap Atoll and at Utirik with studies of stool specimens and serologic testing, by immunofluorescence. Anthelminthic therapy (Vermox) was started on nearly the entire population. A large percentage of the people had positive stools for parasites. The majority of the parasites were eliminated in this island group by the treatment regimen. As part of the expanded medical studies a trailer was obtained for laboratory purposes at the Hospital at Ebeye and a small clinical laboratory was established to support the resident M.D. A Brookhaven National Laboratory laboratory technician/administrator was transferred to Kwajalein to support this A program to educate the people of Rongelap and Utirik regarding radiation and its effects was continued during the past year. During the time of the annual surveys lectures were given to the people by members of the medical team and, in addition, Dr. Naidu, of Brookhaven7 remained on Rongelap and Utirik for a ten-week period indoctrinating the people about radiation. The attitudes of the Rongelap and Utirik people towards the examinations improved, due partly to a better understanding of the objectives of the medical team as a result of the increased educational program, and partly to an improved attitude of the Marshallese politicians. Following the September-October survey of 1979 the inadequacies of the support system and the vessel became the controlling factors. Currently, no vessel is available for support of the surveys. Both the Department of Energy and BNL are actively trying to resolve this problem. When a ship is obtained the survey schedule for FY 1980 will be completed. The planning cycle will probably allow time for two full surveys during this period. In addition, an epidemiological survey of Likiep will be performed, under contract with Tabershaw Occupational Medicine Consultants, to assess the validity of a Marshall Island Government medical questionnaire which indicated an unusual incidence of thyroid pathology in that population.

Page 6

TITLE Iiuman Health Effects from Energy BUDGET AND REPORTING CODE DATE PREPARED Generation: Medical Studies of the HA-02-01-01 03/31/80 People of the Marshall Islands CONTRACTOR NAME CODE WP NUMBER TASK NO, REV. NO, ~of. Technical Progress cont. Expected Progress in BY-2 (FY 1980) cont. During FY 1980 all research records are being reviewed and condensed for transfer to microfiche and finally for computerization. This process requires restructuring the charts in a problem-oriented format to provide the structure necessary for flexible clinical and research utilization in a computerized format. During the last two surveys of FY 1979 there was an obligation to examine and care for the people of Bikini. This endeavor greatly expanded the patient load without supplemental funding, and it is anticipated that continuation of these examinations will be required. Funding, responsibility, and authority for this activity has been under discussion at the Department of Interior and the Department Qf Energy for a number of months but the problem remains unresolved. In addition, if the Likiep survey reveals an increased incidence of thyroid pathology, as is suspected, a medical survey of that island and possibly of Wotje, Ailuk, and Mejit may be required. If these incremental increases occur, the study population would be more than tripled. Emphasis on health and radiation education will be continued and increased to place radiation in its proper perspective in a matrix of health risk for the Marshallese . Continued monitoring of all populations determined to be at increased risk from radiation-induced diseases will continue, focusing primarily on the thyroid, hematopoietic system, breast, lung, stomach, and colon using suitable screening tests. In view of the serious late effects of fallout exposure, continued medical surveillance of the exposed populations is mandatory as the studies are still in the latent period of a number of significant carcinomas. Special examinations for the thyroid abnormalities, as well as for neoplasia of other organs and tissues and other late effects must be continued. In light of the recent renewal of interest of long term effects of “low level” radiation, the data from this study, even though the population is small, should serve as one of the longest prospective studies of the effects of both acute high level and long term low level external and internal radiation. Other studies to be pursued include: a) thyroid comparison studies-- it is hoped that the Department of Energy funas will continue to be approved for carrying out thyroid surgery in the United States on unexposea Rongelap and Utirik people in the extended comparison study where such surgery is indicated; b) reevaluation of dosimetry of the Utirik people, including thyroid doses; c) study of the nature and the treatment of diabetes in Marshallese to include trace element analysis of the people and the ecosystem; d) studies with hemoglobin of Marshallese blood as,an index of somatic mutations associated with radiation exposure and aging; e) studies of polymorphism and rare protein variance in the blood cells of children of exposed and unexposed parents--Dr. James V. Neel at the University of Michigan has expanded his battery of tests for these variants and has agreed to continue these srudies on Marshallese children; and f)

Page 7

TITLE Human Health Effects from Energy BUDGET AND REPORTING CODE DATE PREPARED Generation: Medical Studies of the HA-02-01-01 03/31/80 People of the Marshall Islands Accidental y EXD to Falloutosed CONTRACTOR NAME COOE WP NUMBER TASK NO. REV. NO. Associated Universities, Inc. BNL o 2of. Technical Progress cont. Expected Progress in BY-1 (FY 1981) cont. the process of reducing old charts to the problem-oriented medical records system and the transfer of records to computer storage. Expected Progress in BY (FY 1982). Continuation of the medical surveys and limited primary care of the Marshallese is anticipated on an indefinite basis. Emphasis will be placed on examinations for thyroid abnormalities, the previously mentioned cancers, hematologic disorders and other possible effects of radiation exposure. Coordination with the patient and ecosystem monitoring teams from the Safety and Environmental Protection Division will continue. Chart reduction will be completed and computer storage and medical records will be continued. Data obtained from this study will continue to provide baseline statistics for all studies of human health effects of acute high level and long term low level internal and external radiation. 20h. Relationshipsto Other Projects. The studies of the exposed Marshallese are closely related to the Radiation Effects Research Foundation studies in Japan and to the studizs of the 23 Japanese fishemnen exposed at the same time as the Marshallese to fallout. Acute and Long term low level radiation ranks as one of the most important hazards that must be considered in the EOE medical programs. The effects of fallout exposure in the Harshallese provides valuable information, particularly with regard to thyroid effects from radioiodine exposure, that may relate to future reactor accidents. The longitudinal Marshallese data have been used in the analysis of such accidents. The data are also quoted in other reports such as those of the NCRP, ICRP, BIER, and the United Nations. The Safety and Environmental Protection Division of this Laboratory conducts radiological personnel and environmental surveys of contaminated Marshall Islands and their inhabitants. These studies are closely coordinated with the Work done under this task proposal has either no environmental impact or has impacts similar …