epee
'
ano
OPTION A
The detection and
treatment
of
radlatilun related pathology im capused
am! control populations
‘Note:
Numbers under constraints cefer
lo commun constraints,
1.
Te.
Establish the
Screening?
what pathologic
tdead
tl.
objectives
tindings are soughe?
(A) Thyrodd ¢ Hypoafuaction and/or
neoplusia ~- adenuma of carcinoma
(BD) Breast CA (C) Skin CA
(0) Hemataolupde-leubkemia, nyelofibrosis, aplastic amemia, (E)
GI crace CA (F) Cenetiec sbnor-
Coxt p. 4-4
Conateatuts
Kedascatement of retinged
wbjectives in consideration
of restraines.
radfattion induced problems ue ONL und
Cleveland with good results.
Followeups (2704908) 099010) CLL) (12) *
Our resident MD caa easlly follow op the
Created cases but mot yenecal primiry cace,
malities (sumple size too small
co establish 3 cause * uffecce
Existing Policy
(1704) 05) C6907) (8) 09) (10) * A common
polnt of concace ducs not exist for all of
the aguacios effecting of effected by the
relationship co genetic abnor-
malities) (per Or, J, Neel).
2.0
Treatment:
BNL medical program.
(A) Short-term whatever Creatrent
is indicated tu stabilize the
(a5) (6) 079 CE) (9) CLOVE
transpurted to a desiynated
tertlary care center for
constraints for Option A,
No unique
Projected aceds and demands
towards the pathologic coa-
A o(fers the minimum necds and demands but
(2) 03) C4) 05) (0) 77 08) C9) CLOPCLED® - Opelon
Jitton(s) fuund ac screening
or by tertiary cure.
1.
(A)
will noc mect the Marshallese
expectut fons.
and povernmental agencies involved
agencies and labs involved in the
total care of the Marehallese
in
Flawmetat
aii ae
CHC COV O7PCSD® = optlon A WEED reqatie the fos st open, Padet,
dabebabty.
Mowever,
sipnificaae increase fm U.S. poyments.
care provided wlll
is a common problem to sll
users,
there should be at Jeascone
When: Tining should be based
meetings vs necessary.
mat be Tne lated to insure proper
aust alwa y keep
y
P
in mind
mindcations);2) Long lead Cime and 2
€ixed schedule will do much to counter
the charges that Bul has planned its
trips to the outer islands co coincide
with che absence of many of the luaders;
YD Evenly spaced visits, aboue 24 months
aparc will asaise the BNL field staff ta
the follow-up of the pathologic conditions,
i.e., a relatively fixed cime base line
will cemuve another variable ta data
analysis.
1978
pendit
a
oe
tas
“
rs
“7
te
sd
ained for che Marehall Talands la rather linited. Gur pro&T4 under this option would be constrained to tila Matted
.
th
Wow: The BNL medical coam is
currently doing considerably
Avoldance of eet
With etedecly Tiait
geale the probability of obtataing
valid date and early detection of disease is enhanced by
concentration of funds on Liefted objuctives = lie,, minirum
.
conditions related to radiation exposure in thu caage doter-
Risk
tion” will probably
compromise
heatth
inadequate
medical offered
care. We
quantify
the risks
to tue
faciudus
probably
they vould
optiontebuc
thieunable
by are
progeae
.
ae
4
dilution of effort. However, the public outcry sgainat the
reduction ia the program could have serious political /suciolugic
.
:
consequences.
ar
.
“ty
Pe
Tho ciske to DOE/BNL are: The public reactton to rcduced
fundiag by the Trust
territor
Ei
area.
related pathology. A wellplanned, high intensity educational program would be
necessary to explain why the
mudical program waa: being
teduced ac this time. The
ack of patient couperation (resultion in T data), vigorous
:
so
of care. Risks to the Harshattese are: 1) Failure ta detect
+
~
.
a
Program foe DOE/BNL to,at least eutucn to the previuiow level
Public protest ({lucetly and fetyrnattunal ly) aad a vigorous
"
ve
the poor con-
to
Jedge regarding the tlme inter-|
val for the detection of radla-q
care
Is of preat Importance For the
folluwing ruacuns! 1) Long tead tle
b
The pathologie
the atready
The ciming of the UNL ficdd surveys
will be
This option offers us little Flexibility.
movement to "free associa—
resuit ing
Demuvraplic Population Chiruccectste les (1147) (8)(9)(10)8 - The culture prolidbita direce
expression of hostlilty toward another. A nediatoe must be used. U.S. effores to clarity
grievances unsuccessful co date.
the history, paysical oxae aed laboratory protile ta detect
the earliest deviation {ram “aarmal function” + TSH (tu
document thyrald hypofunction.) Ench tdentified satholozic
condition (Tiated under objectives) will be acreysed by the
approprtate eethodologics. Treateent and foilow-ep will be
fasuced by appropriate algorithes and check lists.
Flexibility
more than studying radiation
proveke lack of cooperation by the Marshallese
Tinting - (2)¢39)(4)(7)* - Marshatlese clas Sujury due bo Joay-term expusure to "Yuw Jevel"
fadfation, Recent US. “low level” studies and feae of long term effects has stcuengthesed
MNacshallese pusicion.
Bikind episode - wedia,
related pathologic conditions (e.g, discase specific items in
tha cost of che educational program to explain the ccanon foc
upon the bese available knowtiun abnormal ittua.
notifficarion
of the study proup +
(especially
on the oucer islands -
in pour cooperation, cumpiiance * wanted Uae, poor data.
wedical criteria and algorithms for the detectie: of radiation
our cut-back fa services and by inflation,
.
annual ugecs meeting vithaddictloaal
i
A detailed research protecel vill bu developed to specify the
and control gepulations whereevee we can Locate cheg.
a cutback
requicements.
b
Pec{ormoece of results
with DOE & BOI.
In addieton, since
the logisticu, e.g., transportation
towever,
CUS) CA} CSV OTP CLEP = Gpelen A offers lowes
Svloerios Crireria
wery cloau
our
em
ures.
The reduction fa the patient population will} be offset by
Wheee: Screening of exposed
Timing
the couts of Tittyation brought by the thistallene tor compennat tat could penuli tn
V.
Total
The cost(s)
tocat cost
the
~
forth
to establish a single contact poing
in DOF co coordinate all these pro-
mary refercal system is almose an absolute
——
Set
Who; BNL medical team hos 25
yeurs of cxpertence NnOption A
foc screening, trcatacnt and
fatluw-up. DOE best sulted to
tdencify single concoct point,
—
:
Existing Facilities|
(7) (8) CO) C20) CAL) * - The lack of a viable pei-
gonscralnt.
of
coordination amung the various
eare of the Marshallese has resulted in con(licting information Crom some concerned U.S.
officials. The resulting confusion has placid
the U.S. in @ vulnerable position - 7 credibility.
vs comission.
(B) Long-tera: fixed protocol ta
follow tecttary/puset operative
cases for the rest of thelr
lives.
level
cicnt coordination of above,
CICA OT OSTEO = The lagk of coue-
abnormalities to determine
their status, e.y., progression
in the
Single contact point £or ef£l~
Sination/bbalson among the many laboratorics
re-
evaluation of any detected
=
objectives of Optlun AL An addl+
tional objective has been peneraced
by the identification of a lack of
Follow-up,short & long-term,
Planning at other levels
Fotloy up:
Short-tcem periodic
Mangewer
not materially change the basic
grams and to establish close Liaison
dufiateive theraay.
(B) Long-term therapy dicected
The relutive constraints vould
An additdonal objective would be
Existing needsand demands
patient uacil he can be safely
{V. Analysis
Develog possible approaches to
attaining the objectives, with
each approach belng stated tn
terms af:
What: Screening (primacy detectton), Treatecnt-shorct-cera,
TU. Translat tos
Present Jevels wl care
Servening: (190729) C10) (11)8
Treatment: (4) - BNL currently treats
t
a
other
thun radiation reluced dfscases - with Increased eure
bidity and aortality among the expoued & xontcol gtoupe. 2}
:i
Possible alienation of the Marehsllese by DOE/SNL renulting
iy
in a breakdows {n vital commenicat ion,
Cost/effectiveneas - No Jata fermut now exisis to compute cost!
effectiveness or cost/henefte., The diffuew funding mechanisna make,"
it very difficult for the principal iavéatiyator is obtaly an
ig
accurate cuttest accounting ef monies expended on the mudical program 4:
If such data were avatloblu sad all acrecoing, tresteunt aid fellowes.
up goals clearly defined, some rough cstimacion of coat/paticat could -"
be derived.
re