MS. PLAZA: Okay. Next we are going talk about the Marshall Islanders.

Again, my name is Eva Plaza from the Department of Justice. I am the moderator here and the next issue we are going to talk about is the Marshall Islands.

And here to lead off that discussion is Thomas Bell, who is a director of the Department of Energy=s Health Physics Program Division of the Office of Health Studies. Mr. Bell?

MR. BELL: Good morning, Ladies and Gentlemen, my name is Tom Bell and I am the Marshall Islands Program Director for our program here in the Department of Energy. And I would like to cover recommendation eight in the three areas that we have to deal with today.

It is my honor to have next to me, Ambassador Banny deBrum from the Republic of Marshall Islands Government. Next to me, to be able to discuss these issues with us, today, Ambassador, it is a pleasure to have you here.

There are three key issues that are mentioned in Recommendation eight. The first is the Department of Energy continue its medical monitoring of the exposed populations of Rongelap and Utirik people. I just want to reiterate very strongly, the Department of Energy is very committed to its program to care for these folks that were exposed to the fallout from basically Test Bravo back in 1954. There has been a whole program for many years dedicated to caring for these patients. It involves an examination at least once a year, if not twice a year and medical follow up in any condition that appears to be radiogenic. And we are very dedicated to that.

In the aging population, that we now are servicing, there is greater need and a greater need for follow up and that is causing us more costs but we burden that to make sure that we care for our patients.

The second issue is a request to look into or review whether other populations beyond Rongelap and Utirik should be added to what they call the exposed populations. The Compact to Free Association Public Law, the United States sets up these two attolds in the area that is covered for medical care. And this really questioning whether that shouldn=t be expanded. There are many issues related to that, that we need to address. Doses one of them, incidents of thyroid nodule disease is another. We have petitioned and are spending money within another office in our Office of Health Studies to do a CDC feasibility study to look into both of those issues. The study is designed to be an epidemiology evaluation of thyroid neoplasia, and exposure to radiation fallout from atopic weapons in the Pacific. And in that we will be looking at both the incidents of benign as well as malignant thyroid cancers throughout the Marshall Islands. And it is our every intent to make sure that the CDC includes Ailuk in those studies. And I think that is the mechanism that is going to be very important in identifying some of the issues.

I will come back to that in a minute. But, I would like to finish one point. And the third point, while we are talking about them, is that the Marshall Islands should be included or involved in a design of further medical research. There has been a request recently for the Republic of Marshall Islands, their representatives to be a part of a medical review, an independent medical review of our programs, so they can involved in participate. We had set up a joint commission on accreditation of health coordination review of the program. And in light of recent requests to expand that and to look at it, we are opening that up to the potential for either a National Academy of Science review, with Research Council or perhaps a blue ribbon panel process, which might allow more participation, Mr. Ambassador.

I think this is one mechanism we can work together on to really try to solve some of the problems we have heard here in the last two days and come up with some answers that will work collectively together.

Now on the Ailuk issue, we need to work together on that, we need to kind of compare notes on what we know about dose and what we know about incidents of thyroid nodule disease in those populations. And in the handout, I have provided some data. I am not going to spend a lot of time going over, but there is apparently some concern on both sides about what those doses really are and what the incident rates really are. And I just might add, it is being complicated by new technologies and diagnostics, such as ultrasound. Which are now taking things beyond the palpation or the feeling range of thyroid nodules, which in the days up until the late >80s, really represented an incident rate of about five percent at Ailuk and in a range of comparison population, which runs from about 38 percent. Today, however, with ultrasound, and this is true in the Firmingham Study here in the United States, ultrasound is allowing us to pick up and detect thyroid nodules at a rate of some 30 to 50 percent. That means half of us in this room have thyroid nodules. Most of us will not come down with any kind of disease state related to that. About 10 to 15 percent of us will probably develop some kind of a mass or tumor, which might affect the thyroid tissue or might lead to cancer. It is those cases that we really want to be watching out for. And our program has been designed to make sure that we spot those quickly and we do the surgeries and the biopsies and things necessary to treat those patients as rapidly as we can.

We, again, look forward to working with you, Mr. Ambassador, and with our colleagues in the Marshall Islands to address these issues that have come up during the Advisory Committee Recommendations. Thank you.

MS. PLAZA: Ambassador deBrum.

AMBASSADOR deBRUM: Thank you, Eva.

Can I ask you how many minutes I have?

MS. PLAZA: You have seven minutes.

AMBASSADOR deBRUM: Seven minutes.

Let me begin by commending both the Clinton Administration for its courage and commitment to begin the uncovering the fact related to the U.S. Government participation in human radiation experiment. And the Advisory Committee for its preliminary research effort. I would also like to extend my sincere appreciation to Secretary of Energy, Hazel O=Leary, for the openness initiative that she institute in the Department of Energy. And this has allowed the Marshall Island Government to gain access for the first time, to the document pertaining to the U.S. nuclear weapon testing program conducted in the Marshall Islands.

There is numerous concern and shortcoming of the Advisory Committee report. The Committee researches what is valuable to the Marshall Islands. This research represents the first independent review of the U.S. Government care for Marshall radiation victim. It is interesting to note that the conclusion and finding of the Advisory Committee report, Committee are quite different from the explanation the U.S. Government has given the Marshall Islands in the past.

These under research of the Advisory Committee, all discussions pertaining to radiation exposure, we are now in party the notion of multiple exposure to numerous population. The Advisory Committee has permanently broader the scope of exposure in the Marshall Islands. Rest assure that the Marshall Island Government will never speak about radiation and exposure in the limited primary of the past. As Dr. O=Toole said yesterday, the Marshall Island Government will work with Congress to ensure that the finding of the Advisory Committee are reflected in the -- The difficulty for the Marshall Islands is that DOE is actively lobbying against our position, and trying to reach the scope of the medical program in the Marshall Islands. It is very difficult for us to influence U.S. public policy, since we are not U.S. citizens.

Let me now turn to our -- in pertaining to the recommendation. I would like to, I would like someone to tell to me what sort of time frame the U.S. Government envisions for implementation of their recommendation.

(1) each of the four recommendations specifically pertaining to Marshall Island being -- Marshall Island Government and the U.S. Department of Energy. In accordance with this recommendation, the -- will actively seek to (1) issue that the exposed committees receive medical monitoring and treatment for the rest of their lives. At present this medical care program is an item in the DOE annual budget. The -- believe that this budget item should be increased in accordance with the number of eligible population and should be a line item.

In addition to the population of medical monitoring and care program, such as -- ensure that Marshalls are involved in the design of future medical research and study.

The last one, establish an independent review of all medical record report and study pertaining to Marshall produced by the U.S. Government. The Arimight Government -- recommendation by the Department of Interior for the National Academy of Science to carry out this independent review. DOE unilaterally establish an independent review of the Marshall Island Medical Monitoring Program with no input from the Marshall Island Government or radiation victims. A hospital -- organization with DOE contractor was selected by DOE for the job. This is certainly what the Marshall Islands had in mind. It wanted to be independent, transparent review and the Marshall Island upcheck to the type of review DOE is promoting. There is no question in that in order to receive medical care, for the Marshall radiation victims, desperately needed -- for the U.S. Government. There are many serious reservation problem with the DOE medical care program. Which continues to produce anxieties, in the Marshall patient, who question the motive of their care provider.

If Marshalls are ever going to feel comfortable, and confident with the care they are receive. It is imperative that they receive full and complete access to information affecting their health. This includes information about the name of people who serve as -- as in human radiation experiment and access to information of medical record.

Document which the Marshall Islands receive from DOE openness represents just the tip of the iceberg. There are numerous and entire collection of documents which the Marshall Islands have been denied access to. Additionally, DOE has to determine if medical record of radiation victim access. Marshall radiation victim was sent military and civil and hospital throughout the United States, to have organ removed and for unknown medical procedure. Translators and explanations were rarely provided. When we asked for medical record, we are repeatedly told that they were destroyed in accidents or fire. Now, it seems there are possible, it is now a priority to at least to confirm their existence.

The DOE is also responsible for the Marshall Island Program lack with the human and final resource to me for -- document. I have little, however, that the same great and powerful nation, which can create and denote 67 nuclear weapon in the Marshall Island, can also muster the resources necessary to produce the documents we request. -- should be covered with further assessment of the document contents. The Marshall Islands with its limited human resources lack the expertise to access all the information contained in that document. And independent medical team must, therefore, be established in order to help the Marshall Islands and the United Government to determine where we go from here.

We would like to see the investigation of human radiation experiment -- There are hundreds of documents which we gave to the Advisory Committee, which were not included in the final report. The Advisory told the Marshall Island Government it was up to us to produce documentary evidence of all human radiation experiment. How that it is possible when we denied access to information. In the case of the Marshall Islands, we have documents which indicate that thyroid experiment took place at Clifton Hospital and generic studies were conducted at Kays Western University. The U.S. Government has yet to consider, investigate this information.

I have some documents that I want to share with Dr. O=Toole, so if she come up and take them.

(Pause.)

AMBASSADOR deBRUM: The Marshall Islands have extreme concern about DOE medical monitoring program, where radiation are currently enrolled. We want medical care for our radiation victims so we can continue to ask for this program. Because this is the only mechanism available to exercise. On the other hand, this is obvious conflict of interest. We have the agency responsible for the nuclear weapon testing, tell us whose is not harmed by radiation in the Marshall Islands.

Furthermore, as many others speakers have pointed out, medical monitoring is totally quite different than medical care. We still like -- we are distant and relatively powerless. We have all concerns. It is the perception of the Governor of the Marshall Island that DOE is not interested in the welfare Marshall=s radiation victims.

There are entire -- that Marshall Islands would not never and the DOE medical monitoring program, simply because of the concern about human --

Interestingly one of the committees are now included in the committee of DOE Human Radiation Experiment. If the United States really is interested in the welfare of the Utirik and the Marshall Islands, it would not confine its research to those areas of its own concern. Several source, received notice yesterday victim are the first one to know and understand what problems they have. Women throughout the Marshall Islands are complaining about their serious reproduction problem, which seem to be associated with environmental exposure to radiation. While the women constantly give birth to deformed children, the U.S. Government focus on thyroid and cancers.

And finally, for all of those individuals and officials of the United States that are working earnestly to help Marshall radiation victims, I want to commend you. Much progress has been made over the past year. But, it is more because of individuals who want to help, rather than official U.S. policy. I have no choice but to look for the future with great -- that we can continue to address needs. If we are honestly going to work together, however, you must first listen to what we are saying. Thank you.

MS. PLAZA: Thank you very much.

Do we have any questions of this particular panel?

DR. EGILMAN: I am not clear how the health care is, this is David Egilman, I am not clear exactly how the health care is distributed. Do they, does DOE provide you with doctors, same thing on the Indian reservation, I know the Public Health Service is in cahoots --

MR. BELL: May I answer that, David?

DR. EGILMAN: Yes.

MR. BELL: Real quickly. We have volunteer doctors. There are about 10 of them that go out twice a year and they offer their time without charge. We pay for their per diem and travel to get them out of there and provide the equipment and the platform, which was a ship until recently. But, we are also doing that now and will be doing that in a land base process. But, the diagnostic equipment, all the laboratory type of stuff, we are all providing that for their care. And they come in and help us to do that.

We also partner with the 177 health care program, that also send docs out to look at their patients the same time.

DR. EGILMAN: Okay, I would suggest then that both for the Navaho, and for the Marshallees, that rather than sending your volunteers, you give them grant, to set up their clinic, to pick their own doctors, to set up, instead of the -- let them be on the board of the clinic, let them run the clinic, let them pick the doctors. A lot of my friends need jobs. And none of my friends work for your agency. And so, certainly, now they are not my friends, so that is my suggestion.

MR. BELL: May I just comment that the Ministry of Health in Armie, does receive U.S. funding to provide that kind of care and the 177 health care program set up for the four athols, most exposed, also is supported by funding from the U.S. So, there is some of that exchange in the community already, it is just a matter of how much it can cover.

MS. PLAZA: Holly?

MS. BARKER: Holly Barker, Marshall Island Embassy. Just a couple of quick comments.

Certainly we don=t want to get into a position where we are arguing over dose reconstruction. I think we have heard from all the communities that that is not, that is fruitless. We can=t really get into that at this point. Certainly it doesn=t look like environmental contamination is being considered through the food chain. There is so much that needs to be explored in the area, but we won=t look at that.

These Ailuk documents that you passed around, the exposure level in these documents were taken from airplanes. Airplanes that flew over that are up to 10 times lower than the actual ground readings. So if we are going to start adjusting, maybe we need to do 10 times every amount that are included in here. These documents also say that Ailuk should have been evacuated. And that was without exception in every single document, that the exposure level there was 3., 3.9 was considered a maximum permissible exposure rate for one year. Even if you take this 6. something figure in your own documents, that is well above what anybody should have been receiving in one year.

But, again, certainly that is something that we need to take up with the Hill. We heard Dr. O=Toole suggesting yesterday and we will go directly to the Hill to discuss that and we would appreciate if we could do that cooperatively rather than antagonistically.

I just also think it is interesting, too, in these recommendations that you sent out, there are four components of the Advisory Committee recommendations, not three. And like Geoffrey Sea pointed out, there are glaring differences in the way that they have been written up here. The fourth recommendation of the Advisory Committee was that there be an independent panel to review all the Marshall Island documents. And that was simply because we flooded the Advisory Committee with work. They couldn=t have possibly gone through all of that material and understood it all. They recognized that they didn=t have the capacity to do that and that was the need to set up the independent review process. So, we would like to see in the future, four components of the recommendations on the Marshall Islands. Thank you.

MR. BELL: Thanks, Holly. That independent review that I mentioned earlier was intended to cover that aspect. And also we did look at soil samples as well as thyroid doses and some other types of things besides aerial monitoring to confirm what we thought the doses were. So, again, we need to work together on your data and ours to take a look at that.

MS. PLAZA: We are going to move on to the next discussion, the Alaskan natives. And we have Mr. Dan Brown, the Chief of the Clinical Investigations, Office of the Surgeon General of the Air Force.

LIEUTENANT COLONEL BROWN: Hi, I am Lieutenant Colonel Dan Brown and I appreciate the fact that Colonel Bailey invited me to come over here and speak to you. I believe one of the reasons for that is, or I guess to state that I have been here for the last day and a half and initially I was somewhat radiance to tell you who I was or what my background is, but I will do that.

I am very proud to wear the Air Force uniform and be in the Air Force and actually in service of your country, as well as mine.

Specifically my background is in, I have a doctorate degree and I don=t say this to be self serving, a doctorate degree in Microbiology and I say it to sort of circumscribe the area of my expertise and my expertise obviously is not in nuclear or medical physics, so I could not answer questions or would not presume to answer questions regarding dosages and potential harm, etc. I also state this again, I say not self servingly, but from the standpoint that I feel very lucky that I had the opportunity to get a doctorate degree, but I do remember something my grandmother told me, as I was getting that degree, when I was in Graduate School and she said, ADan, I hope you remember what the definition of a wise person is.@ And I obviously said, ANo, Grandmom, but I am sure you are going to tell me@ and she said, AWell, a wise person is a person who has gained enough knowledge in their lifetime to understand that they don=t know very much.@

And I think, I state that here because being here for a day and a half, and I am learning a lot from each of you, obviously, and speaking in behalf of my boss, who is the Deputy Surgeon General of the Air Force and bringing up an issue I think that was discussed during the last session, or the last panel that was up here, is that there is the possibility, obviously and I am not an expert here either, but there is a possibility that our whole and this is what he states, is that our whole health care delivery system is totally wrong focused and it has been for over 100 years. We are focused and we train to treat people after they get sick. And we should be focused to prevent people from getting sick and to build healthy communities and to do research not on those things that will help us better treat people that are sick, but to keep people from getting sick and as I stated, the whole vision of the Air Force through him, is focused on what we call BHC or Building Healthy Communities. And I think a lot of you have, I have heard several speakers allude to that process and that whole mind change that we need in the American health care delivery system.

And also, obviously --

(Applause.)

MR. BROWN: To actually define my role in this process, I would and I state it, and I call it sort of BCB and that is not Basilist -- But, or I forgot the B part there, but I call it BCB anyway and that is Before Colonel Bailey, because actually I came into this process before Colonel Bailey. I don=t brag about that in essence, when Secretary O=Leary first announced the openness initiative back in December of >93 and I actually met in the Pentagon on January 8th, I believe it was a snowy Saturday, I remember quite well, because we had a difficult time getting to the Pentagon and we met with Secretary Aspin, who has now passed away and all the charges were given out to the various agencies as to what we were suppose to do with this search. And I was just there sort of as an observer, not realizing that I was going to be part of the process over the next couple of years and I have been ever since. And I can tell you that it has been a very arduous process in terms of identifying all these different experiments, you know. And we have from, we were given the charge to do the search in the Surgeon General office, why specifically, I don=t know because the other Services did it in a different way. I guess I would state, though, that it was primarily because my office, what I am charged with doing, is protection of human subjects and also animal welfare. So we have oversight for the entire Air Force in terms of animal welfare and protection of human subjects.

So, what we did then and I am digressing, I guess, a little bit toward the search, but that is what we actually did. And we actually identified in this process over 1100 studies to the committee. We documented over 50,000 pages of material that we found in the National Achieves out at the St. Louis Personnel Center. And some statements have been made that, you know, that the St. Louis Center, it is easily said sometimes that well, we simply don=t have those records. In sort of a reverse sense, we approached it differently. We went actually through each of the different search directories and help aids, what they call help aids to determine where the records are, what entries they are in. We did that ourselves and we basically told St. Louis, this is the entry we want. This is the record set we want. We know it is there. And then we went out and we actually QC our process and this is not bragging, of course, but it is just a stake that I don=t, you know, personally I didn=t have a stake in the process in terms of what was done 40, 50 years ago. When the Alaskan study was done, I was seven years old, when it started in >55. And so, our full purpose was to identify everything we possibly could and we did go back out to St. Louis numerous times, Colonel Bailey went with us on one occasion and we plan to go again.

I guess I have talked a lot already and haven=t gotten into it, the search, itself. But, basically of those 1100 studies, approximately four major studies were identified, which the Advisory Committee focused on, one of which was the Arctic Air Medical Laboratory Study and I will leave discussion of that to my colleague on my left, Mr. Roper, a detailed discussion of it, although I am very familiar with it also.

So, in essence, it wasn=t a study as defined under the Wilson Memorandum, which has gotten a lot of press, specifically that it pertained to atomic, chemical or biological warfare. In essence, it was a physiological study to attempt to understand the potential of the thyroid in cold adaptions and the potential of differences between natives in Alaska, vice the American servicemen that were also resident there.

As far as making judgements, as I said before, as to the dosages and things like that, you know, I am not a nuclear physicists or medical physicists, so I wouldn=t make comment on that area.

I would make comment within the arena of protection of human subjects and I will tap into what Dr. Ellis had stated before, is I personally feel that the whole process of human subjects protection is a very dynamic and fluid process. You know, we don=t know everything there is know today. There are many, many issues today, as you people have pointed out, virtually throughout every session that we have had here, that we need to work in it, we don=t understand and that the people that in my business, I guess, don=t understand either. And I will grant you that and we need to understand it better. However, I do believe that we have progressed a long way since the, what was called the watershed event of the Nuremberg Code in 1945 and in the 1950s and >60s, where there was intermittent sketchy, if at all, any adaptation of the principals of that code. And most of that progress has been made since 1974. And as I just said, obviously, we need to further improve that, if to use the analogy of the three legged stool, it may have very good antique wood in it, but it needs to be refurnished and refurbished.

Okay. And just to give an overview, the Alaska study of the four major studies that the committee did focus on, one was the Arctic Air Medical Laboratory Study. Another that was conducted under contract with the Air Force was the M.D. Anderson Study, and then of course the Green Run Release and the Radioactive Lathum Study, which the Air Force participated with the Atomic Energy Commission on only four of 254 shots that were done out there. Thank you.