/ 2. é “the doctors don't care enough about the patients to try to treat the condition." Either result is undesirable. These problems in the "philosophy" of screening are not minor. should not be ignored in planning this program. They A close examination of the ac- tual field conditions reveals that the unavailability of adequate treatment and follow-up is the critical preliminary determinant of exactly what should be done in planning the details of medical and biochemical screening for primary care. Screening for research operates under different constraints, usually protected by a committee to inform and protect the research subject (A Human Studies Re- view Committee). Failure to comply with either the research or primary care req- uisites of screening is to invite patient dissatisfaction, litigation, loss of eredibility and poor medical practice. , We have emphasized the problems inherent in "expanded" screening because the research goals of the radiation-related diseases are clearly defined in the "189" in Option A and the spectrum of “expanded health care programs’ in Options B through D. The synthesis we are attempting to achieve is the full mandate of Option A, plus as much of Option D as is feasible under present jurisdictional and funding constraints. DOE clearly has ‘responsibility for Options A and B and the Trust Territories (under DOL) the remainder of primary and secondary care under Options C and D. However, with the new movement to "free association" the re- sponsibility will shift to the administration and people of the Marshall Islands. 4U