staff that we take to the Pacific is a voluntary staff, or at least a staff recruited from major teaching and private institutions, that we.nced to plan addition at, least six months ahead of time for that staff for each trip and : the logistic requirements are specific for each survey, and they reg .re a minimum of three months with four months optimum lead time to order, ship an I sugges 1 have materials ready for the participants when the survey begins. to Dr. Weyzen and Dr. Wachholz that I would like to transfer this information to the Departinent of Interior, specifically to John deYoung and to Ruth Van Cir ve to give them some feel for the magnitude of the problems and the inadvisabil ty of our short term commitments for changes in the BNL medical survey schedule. Since a tentative commitment had been made to Tony deBrum to "do something” before the end of the year, I suggested that since the data that we currencihad available from his survey was open to question that DOE contract with one ar two recognized epidemiclogists and a general medical officer to travel to the islands the islands in question and to redo with sound epidemiologic tech- niques the survey that Tony had presented. If indeed, we find an unexpected incidence of thyroid problems, or congenital abnormalities, on the basis of the available statistics, then we could begin to plan for a more rational and cuonplete medical survey. Dr. Weyzen suggested Dr. Irving Tahershaw Incorpacats.c. This is a contract occupational medicine group operating out of Rockville, Maryland (8~-202~881-6920) and this group had the personnel available to s:ount such a survey. I contacted Dr.‘Tabershaw and he said that he has a group of 32 professionals engaged in occupational health counseltation, ineluding ares of toxicology, epidemiology and industrial hygiene and that he would be delighted to discuss this project with me in the future. From our short conversation, it sounds as though he is very well qualified. He states that he had previously worked with the Atomic Energy Commission and was familiar with the problein. involving environmental impact of radiation hazards. aWe felt that this type of a survey would not completely satisfy Tony deBrum but at least it would give us a much more rational basis for future planning for the care of these islands should it occur. Bruce Wachholz stated that he felt that we should plan sorectime during calendar 1980,preferably during the first six months, a detailed visit to Likiep. I explained to him the constraints of the major BNL trip in January and February and the subsequent trips we have in May and June and he suggested the BNL Resident Physician, Dr. Rittmaster, with a group of contract physicians might be able to make a single survey to Likiep‘and to Wotje covering a period of about four weeks between tHe two previously scheduled BNL surveys. We are currently investigating the possibility of mounting such an effort. It will require significant increase in funding in the PASO office, however, it will be a minimal increase of funding for BNL during the initial survey. However, I'm sure that a survey of close to 1,000 people on Wotje and Likiep is going to discover a significant number of thyroid nodules and if these nodules are hancled as the previous protocol has indicated, they would be returned to the United States for examination at BNL prior to surgery at Case Western Reserve. It would not be unusual to find 20 new cases of thyroid disease in a population this size. This would represent a very significant increase in the BNL budget and expenditures for patient care plus a very large increase in the budget of PASO to support such I discussed with Dr. Weyzen the escalating cost beiny a large survey effort. accrued by the PASO office and received permission to have medical care in These two cases are specifically related Honolulu for Arbela and Aik Riklon. But again they will expand the clinical care to our Rongelap-Utirik study. Dr. Weysen informed me that a Program Manager's money at the budget for PASO. Department of Energy had been returned to the office of the Under Secretary for allocation at that level and that at this point he could make no solid commitnonts