response to a request from the Republic of the Marshall Islands, has permitted the Brookhaven medical program to continue to supplementlocal health care for the exposed persons, stating *..the President....shall continue to provide special medical care and logistical support thereto for the remaining 174 members of the population of Rongelap and Utirik who were exposed to radiation resulting from the 1954 United States thermonuclear "Bravo" test, pursuant to Public Laws 95-134 and 96-205." The Marshall Islands Medical Program is a clinical program which exists for the benefit of the radiation-exposed Marshallese. It is a program of radiation-related disease surveillance consisting of periodic examination and treatment of disease. Additionally, clinical investigations have been carried out by the program over the years, the intent being to identify present or future threats to the health of the exposed Marshallese, hopefully in time to prevent or limit morbidity and mortality. For example, based on the medical program’s early findings of numerous thyroid nodules in the exposed population, thyroxine suppression was initiated for the Rongelap people in 1965 so that thyroid nodules/carcinoma might be prevented. It is possible that this prophylaxis has met with some success. This will be discussed in detail below. The Marshall Islands Medical Program is distinct from the Marshallese Government Health Services, which is a national program of health care which encompasses two hospitals and a network of clinics scattered over some 20 atolls. This network serves the entire population of the Marshall Islands, which numbers over 45,000, whereas the U.S.-funded medical program is directed to assist only those individuais who were exposed to fallout radiation from the BRAVO accident. The Marshall ,Islands Medical Program provides medical aag¢,twice yearly to the exposed and comparison pagniations by visiting the islands where most now regide, namely Mejatto, Utirik, Ebeye, Majuro, and, prior to 1985, Rongelap. Any exposed person who has medical findings suggesting a malignant neoplasm, or other radiation related disease, is referred to secondary or tertiary medical facilities for definitive evaluation and therapy. Those persons with problems that can be effectively managed in Majuro are referred to the Marshallese Health Services. Those requiring a more extensive evaluation are referred to hospitals in Honoluluor, for the special cases of thyroid andpituitary lesions, the National Institutes of Health in Bethesda, Maryland. Individuals needing referral for nonradiation related problems are referred to the Marshallese Health Service where immediate . treatmentis initiated. During the process of providing medical surveillance to the exposed Marshallese, the physicians of the medical program come into contact with children and other family members of the exposed, as well as other inhabitants of the islands. It has been the policy of the Departmentof Energy to support the medical program in its efforts to provide medical consultations by the medical specialists on the mission to these individuals on the basis of humanitarian need and as resources permit. In addition, services of the Brookhaven medical team andits facilities are offered to the Ebeye and Majuro hospitals. On mostvisits lectures by team physicians are arranged and patients referred from the hospitals are evaluated. The medical direction of the Marshall Islands Medical Program and the organization of the medical missions to the Marshall Islands are centered at Brookhaven National Laboratory. The staff of the program includes a physician-director, an administrator, and a medical associate at the Laboratory, and a Marshallese laboratory technician on Ebeye. Atthe time of the missions a variety of physicians are chosen for the medical team, They are skilled volunteers, primarily selected from the staff of university-affiliated or government hospitals, and often with past experience with the program. Direct managementof thyroid disease at the time of medical examination is in the hands of the endocrinologist on the medical team. Dr. Jacob Robbins, Chief of the Endocrinology Section, Genetics and Biochemistry Branch, National Institutes of Health, Bethesda, MD.provides overall management of the thyroid disease facet of the medical program. Raytheon Services Nevada, Inc., Honolulu, Hawaii, under contract to DOE,provides excellent logistical support to the Department of Energy. The Marshall Islands government, provides on request, nurses, translators, and other health care workers for each mission. In the interim between the two medical missions the exposed population has access to the Marshallese health care system. To expedite exchange of medical information, with the