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Subject: Medical Opinion Provided to Copaken and the Government of the Marshall Islands Mr. Copaken and Mr. deBrum submitted the attached at a meeting at the Department of Interior on October 6. (which I did not attend) as evidence in support of their position that radiation-related diseases are prevalent throughout the norther~\Marshall Islands. Presumably, Dr. Merliss was requested to examine t$e population on Wotje Atoll; although, with a single reference to U$irik, atolls are not named in the letter. The point of Mr. Copaken and Mr. deBrum was that problems exist beyond Likiep, that since the Department of Energy has not sent physicians they have hired on their own, and that past information is DOCUMENT DOES NOT CONTAINECI’
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Attorney at Law Beverly Hills, California 90212 At your request I have prepared a suTm,ary of my - op~~~o:>s on my visit to the Nershall Islands . I was deeply impressed by the kindness of the people a:~dby r,~ss of the vice speaker and the president to spend time with us and listen to us. Ily medical background should be set out so that these opinions may be judged. I have practiced internal medicine for thirty-five years. I have been accredited by the Atomic Energy Conrnission many years ago to use radioacti~re isotcpes in medical practice for tl>eatment of certain thyroid diseeses, including h~.pert.hyroidism, and in the diagnosis of thyroid diseases. I think I was one Of the fi~st doctors to be so lice~=e~ for use of radio-. active isotopes in their office in Los Angeles. There rsay have been ten or fifteen Ot-.hersof us at the same six months at UCL.~,teking ccurses in radioactive physics and radiation in general. I used radioisotopes for the diagnosis and treatment of thy~oid disorders up until about five years ago, when space became c~o~ded an~.the lzrge scanner and the devotion of a rocin In my office was BEST COPY AVAILABLE
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no longez desirable. I am certified by the American ~~~rds of Internal Medicine, and am a Fellow of thie American Occupational Medical Association. I am registered in the states of California, Texas, and Illinois to practice rriedicir,e. Finally, as part of my internal medical training, I did one year of intensive pathology. Now for my observation: I was immediately struck by the remarkable frequency of visual difficulties and the frequency of thyroid tumors. The frequency of thyroid tumors was sho’~n by the examination of a nuvber of patients. who demonstrated thyroidectomy scars; by the examlna~lon of SOiT,e hospital record, and most importai]t by the history of the people telling me of the epidemic of these disorders on their islands. Since the populations on the islands varied from two hundred to more, often, particularly in the smaller islands, the individuals who spoke to me wk,ere a’ble to give me a pretty fair idea of the number of thyroid tumors and visual difficulties that appeared on Since the nuclear explosions there has been a rer,arkable epidemic of thyroid ~umors in the Marshall Islands, -- to my kno;+ledge a singular epidemic since I have ne-$er seen its like before, -- starting about fifteen yezrs or . so after the onset of the atomic explosions,.and continuing to the present. Some of the victims apparently were in their teens or pre-teens during the explosions and were most characteristically female but some of the victims ~<ere probably not yet born at the time of the explosion, although I do not have such a conci”se chronology that I can say this with absolute certainty. I recall seeing one patient young enough so that it would be hardly likely that she would have been born during the The thyroidectomy scars that I saw on these patients were large scars, and for the most part it seems to me that the entire thyroid had been removed. This was borne
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out both by palpation of the glands of some of these people, and also their dose of t]iyroid replace ir,ent d~tigs. cation clinically appeared thryroprivic therefore I feel usually ‘&e entire thyroid was r~moved, a type of surgery commonly performed for thyroid cancer and not a simple benign a,denoma. However I understand from several sources that the Brookhaven Institute under the name of Dr. Conard and his associates reports that in the Marshall Islanders “there are only very few cancers of the thyroid found, but that almost all of the lesions of the thyroid were benign adenoAnas. This creates a conflict in my mind, since of the patients, perhaps eighteen to twenty, who had demonstrated to me thyroid scars, one of them was identified histologically as a paDillary adenocarcinoma of the thyroid, (in Guam) and this in a relatively young man; and in case of Cement John, he presented an uGduly hard nodule in the lo~<er portion of one of the thyroid lobes, -- so hard, and so well set apart from the thyroid tissue itself, that I fear this also might be a carcinoma. That rad~ation would produce so many benign a.denomas and so relatively few carcinomas as I a.m led indirectly to believe is difficult for mle to accept. I should, were I involved in further study, like to see sections of all the thyroids removed. G~e should know that the~-e readily arises an . honest difference of opinion that occurs between pathologists as to what constitutes malignancy in thyroid tumors and micxcscopic re-evaluation will be useful. A second opinion based on microscopic re-eve+lua,tionof the tissue
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visual difficulties. I am not an ophthalmologist, and brought no instruments to visualize the lenses of these’s people’s eyes. However, I learned that on one island about fifty per cent of the population is losing lts . vision. This does not come to me from cne informant, but comes to me from three or four informants. One informant actually said that most of the adults were losing their vision. Sometimes it was occurring in children. This again does not seem to be concomitant with the blast or follow shortly on it. One would expect the cataract changes sooner if it was due to looking directly at the blasts, and I would not expect it in individ~als unborn at tie time of the blasts. This appears to be perhaps one of ‘themost disabling disabilities on the island of Utrik, and if not for the appa~ent willingness of the island to take care of its own there would be many people on this island suffering by reason of their dimming sight. In a colder, crueler society these people. would not be able to sumive. The frequency of eye problems is complicated by also the notable frequency of diabetes. Diabetes is an adequate cause of cataracts, and older diabetics may develope cataracts. However I asked very carefully of those patients whom I saw with visual difficulties, -- I assume they had had cataracts some bad been operated on and had cataract removal -- -whether they were diabetic and I understand that while several were, just as many were not, and the diabetic explanation for lll of the cataracts and loss of vision does -not seem cr~dib=le. Again this seems to be a radiation effect. -1 As another radiation effect there was a period of time when there were an unusual number of stillbirths or the birth of monstrosities. I ha-<e heard this called the year of t!!e animal, although I understand this phrase to be offensive to those women who bore such offspring and I heard the particular phrase only from men and not commonly used. It was the time k’hen children were born with incompletely formed bodies, incompletely formed arms or legs, or deformed heads. This occurred late, and not in the nine months after a near-by explosion wlien one would expect radiation effects. Moreover it occurred in islands distant enough so that direct radiation effects governed
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by the univexse square ration rule, emanating immediately from the bomb would be highly unlikely. I think the ill effects still persisting on these islands is not only due to soil contamination but is also due to entry of the radioactive elements with a longer ~ half life into the food, where it has been biologically concentrated, and is eaten by the people. Whether the material that contains the radioisotopes is in one particular vegetable or several or whether it is in the fish or birds, I simply do not know. One would think, that if me lagoon fish were involved, the food-chain exposure would involve only a few islands since I am told that lagoon fish usually stay in their lagoon. If the large fish on the seaside that swim between atolls are involved and carry radioactivity in their flesh, these fish also being eaten by the islanders, one would expect a wider diffusion of the effects of the radioactivity, -- k7hich is xhat has happened. There certainly would be diffusion by birds and actual transfer from one atoll to another of radioactive material in the excrex,ent of birds flying between the attols. The wide diff-~sion of radioactive effects amongthe islands of the ?iarshalls, strongly suggests entry into the food chain witlh transportation between islands. This “ is as yet only an opini,on. Yet otherwise one must assume that the fallout just s~mply was so high, and has spread so far beyond that estimated by ouq finest nuclear scientists that distant islands and distant atolls in the Marshalls were ii~volved, bringing about the radiati;n effects that To my knowledge, two cases of leukemia were found, one in a high government officer, and the other in a boy. There may be others. I am suspicious also that radiation plays a part here also because of the frequency of leukemia in the Nagasaki-Hiroshima survivors. I think that these three: the tumors of the thyroid
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including cancer, disturbances in vision probably due to cataracts, and c?eforn,itiesof birth a~e a part of the raciiaticn injury, and that the continuing injury is in ctive elements. I strongly suspect that the leukemias were radiaticn induced. There are other areas about which I wonder and about which I a,m suspicious, but as yet have formed no firm opinion. I am told by the islanders that diabetes has become very corr.mon. When I spoke to the old people who remerrber the wey the islands were before the nuclear testing, they all routinely deny that diabetes was a great problem for the inhabitants. Now as I speak to the Marshallese, I think that they have more diabetes than the Navajo Indians, and I had always thought the highest incidence was amor,g the h’avajos. Although diabetes is exceedingly cor.mon &nong the Marshallese, I know of no direct radiation effect that causes diabetes. On the other hand, I do not know all that is to be kncwn about feed chain radiation injury and neither does anybody else. Our particular human experiences on radiation have been either with therapeutic radiation or the exterior type of radiation at Hiroshima and Nagasaki. Knowledge about food-chain radiation is scant and I am unable to say whether the diabetes is related to the radiation or There are some sexu~l probler,s anong the males of the island, or among the fe,males. A number of men from one atoll had told me that they develcped a failure of sexual interest after the explosions, this ~ersisting, and in several cases their families did not ex~a.nd after the bomb blasts. This’ also is likely radiation induced but I cannot say whether this is food-chain or whether this is perhaps external radiation coming from the soil, since the testicles are in an exposed posi.t’ion,particularly in people who so com.ncnly sit on the ground or squat as do the people of the :flarshallIslands. Immediate effects of the radiation occurred in some individuals who spoke to me, these changes consisting of hair loss, and burns of the skin. The burns of the skin occurred in those islanders in which there was a dusty, powdery fallout after the explosion called Bravo, which was effected by metereologic or inadvertence. There were
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deaths from these ulcers, according to the memory of the individuals that I spoke to. Startlingly, I WaS told repeatedly of deaths on Utric in the month following the bomb blasts. Several people from Utric told me of three in the month following the fizst blast, at least two of them being in children and one, to my memory, in a young woman. One suspects that this immediate type of response is due to direct radiation connected directly with the fallout, and probably not food-chain, although absolute certainty is not available. All of the people have consistently told me that the d~acje to the vegetation and the foods that they eat, -- extremely limited to start with -- has been devastating” The Marshallese eat a limited diet consisting of fish, breadfruit, coconut, and arrowroot. The most sensitive to radiation of the plants pro~-ed to be arrowroot. But this ~’as a highly important foodstuff on these small islzz<s. As I understood from the Flarshallese that I spoke to, before the blast the arrowrootgrew as a tuber or rhizome on the root of a bushy type of plant. A healthy arrowroot plant would have six or so tubers, and would . yield a good deal of nutritious food. After the blast, the arrowroot plants themselves started to diminish and the number of tubers on the roots decreased until the point came at which the arrowroot has almost been lost on some of the islands and ,no longer serves as a staple in Lhe diet. The Marshallese describe to me the tubers shrinking to two to three on a bush,. and then to small tubers, and then to the plant just not ~ro~ing at all, or growing in a deformed manner. Similar effects occurred in the coconut trees. The tops of the coconut trees turned red or brown after the blasts, and many coconut t~-ees have not bol-ne as well since. The breadfruit trees have borne smaller fruit and often deformed fruit. Some of the trees themselves have become deformed. I am also struck by the high incidence of hyperten-” sion in the people of the Narshall Islands. The incidence of hypertension in the average white American male goes up to about five per cent depending on age. The freqency of h>~ertension however among the .Marshallese far outnumbers that, and judging from the hospital records that I looked
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at when I visited the hospital, and the answers to the questions that the people gave rie, the incidence of hypertension is probably over t~enty-five per cent and might be in the older people as high as forty per cent. For scme years now general medical opinion indicate that hypertension is a stress disease. It can be induced in animals by crowding. If one takes experimental animals of small size, -- rodents, for example, -- and puts them into large cages where they are free to move about, there is no particular increase in h~rertension. If one puts. them in small cages where they are crowded a good deal, and …
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