[In December, 1978, 1 developed a position paper discussing sone of the most pressing, problems facing, the DOE/BNL Medical Survey. In thac paper T attempted to present a spectrum of solutions, ranging from purely a resercch comuitment to tota] medical care for the Narshallese affected by atomic weapons testing in their islands. Since that time, a number of new prablrems have arisen and should be addressed format. in the context of the original systons analysis These uew problems vill not basically change the options presented in the flow sheets but will modify some of the constraints,and require a reass ssoment and/or restatement.of the priority of some of the objectives. Historically, this progran has had rather a narrow focus, Looking for radiation-relatcd patholopy, particularly in the thyroid, v-g., thyroid avenuia., carcinomas, and btologic hypothyroidism, and in the hematopoictic system, c.e., blood dyscrasias in the study group. Over the last year a number of new problems have emerged that will probably require a sizeable inerease in the seope of the program. They are: 1) New data (previously secret) has revealed thar Likiep Atoll received detectable fallavt after the 1 March 1954 detonation. Mr. Anton DeBrum, Secretary of State of the new Marshall Islands government, designed and circulated a medical questionnaire to the residents of Likicp. results of that questionnaire were delivered to the U.S. The Government and the U.N. with a demand that “something” be done to evaluate the situation on Likiep. Wo. are currently working with an independent epidemiologic consulting group to verily Mr. DeBrum's Findings. Jf, in fact, Likfep shows a significant Incrcase in birth defects or selected cancers, then the DOE fecls a full medical survey of the islands in the Likiep Atel] should be undertaken. An ancillary problem that must be considered is the geographical Location of Likiep. If Likiep shows an increased incidence of possibly radiattion- related pathology, then a number of atolls Tying between Likiep and the