OPLION A
The detection and treatment of radbat bon related pathology in exposed
and control populations
‘Note:
Numbers under constraints refer
lo common constraints, text p.g-¢/
1.
Eseablish the ideal objectives
Screening:
What pathologle findings are sought?
(A) Thyroid + dypofunction and/or
Til.
Itt. Translation
Reinstatement of refilaed
Constrainca
Freseatof
Screening: (1)(7) (9) (LO) (11)"
Treatment: (4) - BNL currently treats
radiation induced problema at BNL and
neoplasia - a4denuma or carcinoma
{B} Breast CA (C} Skin CA
(D) Hemarologic-leukesia, syelofibrosis, aplastic anemia, {E)
Cleveland with good resules.
Fullow-up: (2)(4)(8),(9) (10) (11) (12)4
malities (sumple size too small
te establish a cause + effect
relationship to genetic abnor-
ExlutingPolicy
GI tract CA (F) Cenetic abnor-
malities) (per Dr. J. Mvel).
2.0
Treatment:
(a) Shorc-cerm whatever treatment
is indicated to stabilize che
patienc until he can be safely
transported to a designated
tecthacy care center for
definitive therapy.
{8} Long-term therapy dJrected
towards the pathologic condition(s} Found at screening
or by tectlarcy care.
2.
(A)
Follow up:
Short-term periodic re-
evaluation of any detected
abnormalities Co determine
their status, €.%-, prugress!on
vs remission.
(3) Long-cerm: fixed protacal to
follow tertiary/post operative
cases for the rest of their
lives.
objectives in consideration
of restraints.
The relative constralnty would
not materially change the basic
objectives of Option A. An additional objective has been generated
by the identification of a lack of
coordination among the various
agencies and labs tnvolved {n the
tocai care of the Marshallese
Our resident MD can easily follow up the
treated cases bul not general primary care.
(19 (49.05) (6) (7) (8) (9) (1094 A common
point of contact does noc exist for all of
the agencies effecting or effected by the
BNL medical program.
Existing
needa and demands
£4) (5) (6) (7) (8) (9) (103 (LV) *
An additional objective would be
to establish a single contacc point
in DOE to coordinate all these programs and to establish close liaison
No unique
wich DOE & DOT.
cunstraints for Option A,
Projected needs and demands
(2) C3) (43 (5) (6) (7 (8) 099 (10) (LL) + Option
there should be ac leasctone
annual users meeting with addittonal
A offers the minimum needs and demands but
will noe meer the Marshallese expectations.
Plunuing at other levels
1) 2903) (5) (6) (7) (8) * - The dack of coor-
dinacion/iiaison among the many Laboratories
meetings
tection), Treatmeit-shore-term,
Follow-up,shert & long-term,
Single contact point for efflcient coordination of above.
and control populations whereever We can lucate then.
When: Timing should be based
upon the beset available know
in the level of care provided wilk provoke lack of couperation by the Marshallese reauleing
in poor cooperation, compliance » waste time, poor data,
€2}(9)04)47)* - Marshallese clalo injury due to long-term exposure ta "low level"
Recent U.S. “low levet” scuties and
radiation.
Bikinl episode - wedia.
“srshallese positlon,
fear of ong term effeces has strengthened
Bowyruplic_ Pupulation
Charactyrisrics ()(7)(B)() G0)* - The culture prohibles direcr
PRs
Awmedlator mast be used,
ULS.
efforts to clarify
reduced ac this time. The
following reasons: 1} Long lead rime
(especially on the outer islands - we
must always keep in mind the poor communications);2) Long lead time and a
fixed schedule will do much to counter
the charges chat BNL has planned its
trips to the onter isiands to coincide
wlth cle absence of many of the leaders;
3) Evenly spaced visits, about 2% months
apart will assist che BNL fleld staff in
the follow-up of the pathologic conditions,
l.e., a relatively fixed time base Pine
will remove snother variaube in data
ailysrs,
Flexibility
This option offers us liccle flexibility.
conditions related to radiation exposure
The pathologic
in the range deter—
mined for the Marshal] Istandy Is rather bimbted.
Ueno pro-
Avoidance of untoward consequences
With scrictly Limited goals the probabilicy of obtaining
movement to “Free asfocla—
tion” will probably compromise
must be included co insure proper
notification of the study group -
out Cut-back in services and by inflation.
How: The BNL medical team is
wucy referral system is almost an absolute _
constraint.
—
Ilowever, a curback
in
the earliest deviation from “normal funceion" « TSH (ta
document thyroid hypofunceion.) Each identified patholugic
conditton (listed under objectives) will be sereened by che
gram under this opiion would be construined to this limtted
medical program was being
is of greac importance for the
itema
the history, physical exam and laboratory profile co detect
Jedge ccgarding the time f{nrerval for the detection of rudla-
necessary to explain why che
The timing of the BNL Cield surveys
related pathologic conditions (e.x%, discase specific
Wnere: Screening of exposed
eational program would be
Timing
A detailed cesearch protocel wil) be developed to specify the
medical ceitecia and algorichms for the detection of radiation
Total coat(s)
The togat cose will be very close to u
'd expenditures,
The reduction in the patient popularion
orfgoc by
the cose of the educational program to ex,...6n che reason for
Existing Facilities—
However,
Ve
Selection Crirecta
forth the eriteria tor the seleccion of an goprogcti
opptopriate methodologies. Treatment and fullow-up will be
assured by appropriace algorithms and check Jists.
BNE medical team has 25
far screening, treatment and
follow-up. DOE best suited to
identify single contact poink,
more than studying radiation
related pathology.
A wellplanned, high intensity cdu-
(7) 8709) 10) (LL)* - The lack of a viable pri-
Set
Performance
years of experfence inOprion A
Whe:
currently doing considerably
offictaly, The resulting confusion has placed
the U.S. dn a vulnerable position - 7? credibiliry.
= (19090 65) (5907) QA1L)* - Gpedon A offers lowest requirements.
croresstion of hustilicy toward another.
Efievances ensuceesstul co dure,
Analysis
tion abnormalicics.
'
the costs of Litigation brought by the Murshathese for compensatton could result ia
significant increase in U.S. payments.
~~
necessary.
cace of the Macshaltese has resulted in conflicting information from some coucerned U.S.
Financial
Taming ~
ag
and governmental agencies involved in Che
“CYS (6) (73 (8)* - option A will require the lowest operating budget, inicially.
Minpower
In addition, since
Che logistics, e.g., transportation
{8 oa common problem to all users,
IV.
Develop possible approaches to
attaining che objectlves, with
each approach being stated in
terms of:
What:
Screening(primary de-
the already tnadequate health
care funding by the Truse
Territory.
area.
valid data and early detection of disease is enhanced by
concenteation of Funds on ltmited objectives - L.e., minimum
dilution of effort.
However, the public outery apainst the
reduction in che proyram could have serious policical/suciolopic
consequences,
Risk
The risks to DOE/BNL are: The public reaccion to reduced
medical care.
We are unable to quancify cin risks to the
Program offered by this sprion but they would probably In¢lude:
lack of patient couperacion (resuleting in ? duta), vigorous
public protest (locally and internationally) and a viyorous
Program for BOE/BNL to,at least, tetucn to the previous level
of care, Risks to the Marshallese ure: 1) Failure to detect
other than radiation related discases - with increased surBidity and mortality amuny the exposed & control geuups. 2)
Possible ailenation of the Marshallese by DOE/GXL resulting
in a breakdowns Jn vital communication.
Cost/etiectiveness ~ No data format now exists te computy cours
effectiveness or cost/benefit.
The diffuse funding mechanisms muke
it very diff€icule for the principal inveatiyacer ro ohtadia on
accurate current accounting of montes expended ca the mdtcal propraum.
[If such data were avallable and all screentag, Creatjeont wud follows
up gouls clearly defined, some tough vstimacion uf cogt/par dent ceoadd
be derived.