oq TT r. beret bed oe t_iL hw. f att A aflbeer IN CONFIDENCE -4what examinations one is about to make, and cannot explain the purpose or results of each. It was of outstanding value that Dr. Ezra Riklon first obtained from all who were being examined, an account of any sympotoms they had, and then explained the nature of the intended examinations. In addition, if any abnormality was detected or suspected from the examination, he asked, or interpreted, additional questions to amplify the "history" and to make sure that the individual understood the position and any necessary action. I understand that this arrangement was introduced on this 1972 visit and I would expect that difficulties in communication will have been much reduced by this, particularly in view of his sympathy and his deeply humane and positive personality. On this general point, I understand that unirradiated people had questioned why they also should be examined and should be exposed to blood sampling and other tests. I was concerned to hear this since, if so, it would imply that their help had not been clearly asked for, or understood to be, on the voluntary basis that such help would be valuable, or essential, to the proper care of their irradiated fellow people. The point here is that if, for example, thyroid nodules were common in unirradiated islanders and did not progress to malignant forms, the proper management of nodules appearing in the exposed people mignt be quite different from that 1£ such nodules were rarely seen in the unexposed. It would certainly suggest a failure of communication if the co-operation of unexposed people had not been asked for and interpreted as an offer of their help. 1(d). I examined microscopic sections of nodules removed at operation and see no grounds for disagreeing with the diagnoses - of benign or malignant forms - that have been made. The pathologists who have examined and reported on these sections include men who are internationally accepted as expert in thyroid pathology. . 2(a). Past medical treatment seems to me to have been on normal and orthodox lines, and appears appropriate. In particular, (i) The treatment of any significant depression of thyroid activity by a synthetic thyroxine preparation - in this case "Synthroid" -~ is a routine, and the regular blood tests (for protein bound iodine and, when the test became available, for the thyroid stimulating hormone) enable deficiencies to be detected early. Taking the whole weekly dose oF Ln of Synthroid at one time once a week is reasonable, given the slow utilisation of this hormone, and makes it more likely that the appropriate average will be maintained than if doses are to be given daily. It is of course important that Medical Aides should check that correct supplies of tablets are in fact collected regularly. 225 / continued...