f
2
to have aircraft support to most of the islands and in addition, each of the

islands has a small dispensary.

B. A budget to provide transportation and per diem for team members as
well as reimbursement for capital equipment and consumables.
C. A well recognized 25-year history of medical surveillance in this area
with an established program and many contacts in the health care delivery field
and in the political arena.

F.

An opportunity for exposure to a new third world nation with all the

problems and the challenges of a “new health care delivery system".

G. An affiliation with the Brookhaven National Laboratory Marshall Islands
Study collaborative group which currently includes a top flight panel of national
and international consultants in many fields (please see Enclosure A).

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E. A close liaison with the Department of Interior, i.e., in the political
status negotiations.

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D. A coordinating point for logistics in Honolulu under the Pacific Area
Support Office of the Department of Energy.

H. A field setting for the training of house staff in tropical medicine
and in problems of developing third world health care program, i.e., the
medical economics of a developing a primitive system.
I. The possibility to setup a whole series of research projects to improve
the health status of the Marshallese. These studies might include such things
as further investigation of the high incidence of maturity onset diabetes (much
like that of the Pima Indians).
Current speculation is centered around the
question of a receptor site defect and/or a lack of an active coenzyme that
may be dependent upon trace elements such as chromium. A second, very lucrative
area might involve the delineation of the unusual biochemical profiles of the
Marshallese. We feel that this needs careful HLA studies and would be prepared

to support the establishment of a tissue culture facility on Kwajalein.

J. This study has "evolved" over 25 years. At the present time there
appears to be a good possibility that the program will expand rapidly. Our
present study group numbers about 450, the possible expansion could reach 2,000
in the next year.

The expansion groups are really, epidemiologically, different

than the 450 “high dose" exposure group. The new group could be called a “range
of low level -— long term exposed persons."
Therefore, a good, coordinated preplanned epidemiologic study could be devised before the study is begun.
This is
probably the most compelling reason for basing this study in a department such

as yours.

A.

Qur traditional research mandate from the Department of Energy has been

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On the other hand, the reasons that Brookhaven National Laboratory and the
Department of Energy should form such a collaborative effort would include the
following reasons:

Select target paragraph3