er me reg epee COVINGTON & BURLING Mr. Wallace 0. Page Nine December 17, Green 1980 seen we emer ae Loeffler, who has attempted to identify some of the medical information which must be obtained in order to determine the extent of potentially radiation related abnormalities in the Marshall Islands, advised us that since radiation induced carcinogenicity requires long latency periods (10-20 years for some solid tumors) retrospective analysis of incomplete, nondirected medical records are clearly inadequate to establish possible secondary deleterious effects. Recceg- nizing that the proposed surveys of health effects will of necessity be incomplete, Dr. Loeffler is of the view that we must attempt to provide answers at least to the following specific questions. I. What evidence exists of developmental effects associated with radiation? This may be established by individual and population data of histories and physical examinations to include anthropometric data (adult and pediatric). Population genetic studies including cytogenetic chromosoural analyses should be conducted. II. What evidence exists of late somatic effects associated with radiation? This determination would require: a) Thyroid cancer and malfunction screening to include: - History and physical examinations - Technitium radioisotope gamma camera imaging scanning (alternatively radioactive Iodine scanning) - Biochemical analyses including Thyroglobulin determination by radioimmune assay - T4 and TSH by radioimmune assay - standard SMAC 20 for general screening purposes (Calcium, Phosphorus, Alkaline Phesphatase and Cholesterol included) - Thyroxine Binding Globulin determination - If indicated, in selected cases, needle aspiration biopsy for cytological examination and possible surgical intervention b) Leukemia screening to include: - History and physical examination - Complete peripheral bloodcount 7