INTRODUCTION AND STATEMENT OF PROBLEMS war. Cert < 4 On October 3, 1978, a meeting was held at the Department of Energy (DOE) Ok hh eeForte Te a Headquarters in Germantown, Maryland, to discuss a number of problems related to the DOE position in relation to several different programs in the Marshall Islands. The Medical Program, under the auspices of Brookhaven National Laboratory (BNL), generated a great deal of discussion, concerned primarily with the following problems: 1. The research mandate of BNL for the study and care'of radiation- related diseases in the exposed populations is clear. However, over a period of twenty-five years, that mandate has been expanded to include care for non~ radiation-related diseases. This evolution has been necessitated by the virtual absence of adequate primary care in the Marshall Islands. The BNL medical team has responded in a humanitarian manner to diagnose, treat, and follow-up a number of pathologic conditions which, if untreated, would have led to increased ‘morbidity and mortality in the exposed and comparison groups. A. Basically, the BNL Medical Program is a medical research progran. Its original goal was to "sereen" for and detect the earliest changes suggestive of radiation~related pathology, and to treat those lesions as indicated. (The World Health Organization (WHO) states the primary responsibility of any screening effort is the ability to resolve all “abnormal” findings and to assure the patient of referral to an adequate primary care center.) B. The difficulties are compounded by the fact that valid pre- exposure health care statistics are difficult or impossible to obtain. The Medical Program is in the untenable position of having to deal often with the probability that a specific pathologic condition is or is not related to a er 5 Peer, aroe kee veve e x es a: ieradet ayrage rat fe ee ee Ba ay » aiak " eR f es Sysshite ory