ia . PRATT, HUGH S. - . ~ eo eee mee ones 125- 14-6535 eee ee Lk nk eee - Due to the small number of. exposed and the mobility of the total study group among different atolls, the analysis of detected pathology (observed/expected—— obtained by enhanced vital statistics) leaves a very large standard error. The longevity of the study and the frequency of the examinations has strengthened the anelysis and by judicious grouping of subpopylations, some meaningful analysis is possible (particularly in Rongelap, exposed at less than age 10). A review of the data base by Dr. Brian MacMahon, Professor of Epidemiology at Harvard, has strengthen the analysis by advising the re-establishment of the cohort study. . Pitfalls: The pitfalls and Limitations in the study can be discussed in the following . framework: A. am Lo * . . ve. 7. : . 7 : Methodologic 1) The changing carcinogenic environment duringthe study r question of the control for these variables. Doss as the . 2) The small (244) exposed groups and. the heterogenous control/coaparison groups makes statistical analysis difficult. . _ 3) The dichotomy between the research goals and the humanitarian primary care demands of the study has led to misunderstanding and misconceptions among the scientific and supporting groups and between the scientific party and the Marshallese both within and outside the study group. B. - Political 1) The accident victims have suffered severe psycho-social trauma. They are truly a unique subpopulation of the Marshallese, with a different perception of the goals and responsibilities of the study. 2) U.S. and/or Trust Territory policies of repawration/compensation has , reinforced #1 (above) and in some cases has subsidized “illness” as opposed to rewarding “health”. mentality. 3) This philosophy has supported an "illness"-oriented welfare . The international abreaction toe nuclear weapons has given the exposed group and their supporters throughout the world inordinate political leverage, through litigation and adverse public relations (anti-U.S.+ AEC +» ERDA + DOE ~+BNL). 4) The program, since its inception, has been a cooperative effort between the medical team and the TT health care delivery system. At the present time, the Marshallese are moving rapidly towards a political status, unique in international law, called "free association". Basically, the U.S. would retain the use of "strategic areas" but the newly-established Marshallese government would control most other internal and external mechanisms of a new nation. Current negotiations have stressed the continued responsibility of the U.S. for follow-up of the study groupThere is no clear delineation between primary care, responsibilities of the new government and the DOE/BNL program. The provisional leaders are currently seeking a contract HMO to C. take over their health care delivery system. Geographic 1) The smahl land mass in relatioa tu the huge gosographic area of Marsheiis presents seriou. communicucton amd trancpartution problemas. 7 the The Logistic