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). Rr re eeeee E. A close liaison with the Department of Interior, i.e., in the political status negotiations. ee 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 wrote ee ye 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: