Mr. Richard D. Copaken July 23, 1980 Page 2 camprehend how this small sampling of another atoll, will provide a comparison standard, if, after "26 years of medical follow up study” of the inhabitants of Rongelap and Utirik, no standard on other atolls has yet been established. The entire problem of establishing a standard reference for normals, is further complicated by a more basic issue. Even if one were to assume the current availability of a comprehensive hematological and biochemical Standard, it, in itself, may not be truly "normal" because of possible direct or indirect prior effect of radiation exposure on this "standard" population. . There are several other intrinsic shortcomings of the proposed study: l. - The proposal outlines a single screening attempt at one point in time. Since radiation induced carcinogenicity entails a lengthy latency period, future interval screening of the same population would be required to assess possible radiation related health effects. 2. No provision is made for anthropometric data collection 3. The term "clinical studies" as proposed, is generic and and assessment. non-specific. If it truly implies a complete physical examination, it should be so stated. Paragraph four (indicated as "2." in the March 27 1980 proposal) should not read "The Department of Energy will send to Likiep a physician for the purpose of examing the population with respect to detecting the existence of thyroid nodules" but should read: "The Department of Energy will send to Likiep and other atolls physicians to carry out complete physical examinations on the population." 4. a The proposal, as written, provides that "medical problems" (whether possibly radiation related or not) will be referred to a medical officer of the Health Services of the Govern- ment of the Marshall Islands and that treatment funding will be the responsibility of the Department of the Interior/ Trust Territory of the Pacific Islands. I find this difficult to comprehend since the medical officers of the Department of Energy and Brookhaven National Laboratory advised us at “- our April 23, 1980 meeting, that they have in the past provided requisite treatment, including stateside transport, surgery at U.S. Hospitals, etc., for even “remotely possible :7 radiation effects".