INTRODUCTION AND STATEMENT OF PROBLEMS On October 3, 1978, a meeting was held at the Department of Energy (DOE) Headquarters in Germantown, Maryland, to discuss a number of problems related to the DOE position in relation to several different programs in the Marshall Islands. The Medical Program, under the auspices of Brookhaven National Laboratory (BNL), generated a great deal of discussion, concerned primarily with the following problems: 1. . The research mandate of BNL for the study and care of radiation- related diseases in the exposed populations is clear. twenty-five years, However, over a period of that mandate has been expanded to include care for non- radiation-related diseases. This evolution has been necessitated by the virtual absence of adequate primary care in the Marshall Islands. has responded in a humanitarian manner to diagnose, ber of pathologic conditions-which, The BNL medical team treat, and follow-up a num- if untreated, would have led to increased morbidity and mortality in the exposed and comparison groups. A. Basically, the BNL Medical Program is a medical research program. Its original goal was to "screen" for and detect the earliest changes suggestive of radiation-related pathology, and to treat those lesions as indicated. (The World Health Organization (WHO) states the primary responsibility of any screening effort is the ability to resolve all “abnormal" findings and to assure the patient of referral to an adequate primary care center.) B. The difficulties are compounded by the fact that valid pre- exposure health care statistics are difficult or impossible to obtain. The Medical Program is in the untenable position of having to deal often with the probability that a specific pathologic condition is or is not related to