!
.
. refer
'
|
by the identification of a hack of
agencies and labs involved in the
Who:
.
ids but
stations.
there should be at least one
i
at ial users meeting with additional
meatings as necessary,
‘
s£ coariratorLles
in the
|
1 in con-
.
zrned U.S.
has placed
? credibility
,
a viable pri-
j
~~
lly.
ult in
,
However,
9 “low Level"
strengthened
its direce
ts to clarify
The timing of the BNL field surveys
Whent Timing should xe bas.4
2, consequences.
planned, high intensity edu-
, Risk
related pathology-
with the absence of many of the leaders;
3) Evenly spaced visits, about 245 months
apart will assist the BNL field staff in
the follow-up of the pathologie condic ion:
d.e., a teloticvely Fixed cine base Line
BAS? ? ? 5
=o
A
-
fixed schedule will do much to counter
et
ae
4
4 f area,
more than studying radiation
.
ms
The pathologic
upon the best availayl know IE
ledge regarding the tise i-terAvoidance of untoward consequences
val for the detectio: of rdiaWith strictly limited goals the probability of obtaining
tion abnormalities.
¥ valid data and early detection of disease is enhanced by
concentration of funds on limited objectives - i.e., minimun
How: The BNL medical ivam is
7 dilution of effort.
However, the public outery against tie
.?
currently doing considerab y .
* reduction in the program could have serious political /sociolegic
must always keep in mind the poor conmunications) ;2) Long lead time and a
.
_.
.
i
ry
“fy,
°
and control populations where!J, conditions related to radiation exposure in the range deterever we can locate tiem.
“emined for the Marshall Islands is rather limited,
Our proib gram under this option would be constrained to this limi:ed
4 well-
Terricory.
following reasons: 1) Long lead time
the charges that BNL has planned its
trips to the outer islands to coincide
‘
Flexibility
This option offers us little flexibility.
care funding by the Truse
is of great importance for the
notification of the Study group (especially on the outer islands - we
;
The cotal cost will be very close to our 1.78 expenditures,
The reduction in the patient population will be offset by
the cost of the ec 1cational program to explain the reason for
Our cut-back in services and by inflation,
io
f
.
;
.
;
.
The risks to DOE/BNL are: The puolic reaction to reduced
medical care.
We are unable to quantify the risks to the
program offered by this option but they would probably ii-iude:
lack of patient cooperation (resulting in ? data), vigorous
movement to "free a-socia| public procest (locally and internationally) and a vigorous
tion" will probably 2" orer ise - * program for DOE/BNL te,at least,return to the previous level
the already inadequace wealth
of care. Risks to the Marshallese are: 1) Failure to detect
7
Timir +
ol
',
reduced at this time. The
must be included to insure prope:
Ver, a cutback
lese resulting
BNL medical tea has 25
cational program Would be
necessary to explain why the
medical program was beisty
.
‘solute
‘
- Total cost(s)
Where: Screening of exposed
{ with DOE & DOL.
In addition, since
i the logistics, e.g., transportation
is a common problem to all users,
.
condition (listed under objeccives) will be screened by tha
appropriate methodologies, Treatment and follow-up will be
assured by appropriate algorichms and check lists.
years of experience iaOption A/}’
for screening, treatient and
'
follow-up. DOE best suitec to
+
identify single contict oint.
, grams and to establish close liaison
TSI (to
document thyroid hypofunction,) Each identifted pathologic
cient coordination of above.
| total care of the Marshallese
:
"An additional objective would be
} to establish a single contact point
‘ tn DOE to coordinate all these pro--
Option
.
4 the enrlfest deviation from "normal function" +
Screening(prinary de-
teccica). Treatment-hort-term,
Follow-up,short § long-term,
Single contact point fer effi~
| coordination among the various
lve
teres of:
What:
i aot materially change the basic
objectives of Option A.
An addi“ tional objective has been generated
alt cf
xy the
|
ee
ee
IW. Analysis
;
A detailed research protocol] will be developed to specify che
~~
Develop possibleapproaches to.) Medical criteria and algorithms for the detection of radiation
attaining the objectives, with ,, Yelated pathologic conditions (e.g; disease specific items in
each approach being stated in
the history, physical €xam and laboratory profile to detect
armen
| fhe relative constraints would
‘on
- ~V-_SelectinnCriteria
|__Set forth thecriteriaforthe selectionofanapproach:
Performance
LIL. Translation
nnn lainstatement of refined
wbjectives in consideration
‘ats
‘;o&
restraints.
i
b
ye
> the
y care.
ee. tennee
35
SRA
other than radiation related diseases - with increased nor-
bidity and mortality among the exposed & con-rol groups. 2)
Possible alienation of the Marshallese by DOE/BNi resulting
in a Hreakdown in vital conmunication.
Cost /fefFectiveness ~ No data format now exists to compute cost/
effectiveness or cost/benefit, The diffuse funding mechanisns make
it very difficult for the principal investigator to obtain ar
accurate current accounting of monies expended on the medical
proer
Tf such dat. were available and all screening, treatment and col’
up ZOais Clearly defined, some
be derived
cot ee
9 } 9 2 2 2 9
.
s3ugh est “ation of cost/patient
rL
“
te
rs
em
i
mi