Witness Panel 1

• Dr. Kiyohiko Mabuchi

  Read statement

  Witness Panel 1

  Dr. Kiyohiko Mabuchi

  
  Chairman Domenici and Members of the Committee on Energy and Natural Resources, thank you for the opportunity to testify on behalf of the National Cancer Institute (NCI) of the National Institutes of Health, an agency of the U.S. Department of Health and Human Services.  I am Kiyohiko Mabuchi, M.D., Dr.P.H., an Expert with the NCI’s Division of Cancer Epidemiology and Genetics Radiation Epidemiology Branch.  My testimony will describe the findings from NCI’s October 2004 correspondence with this Committee, discussed below, and will describe some of the scientific uncertainties associated with our findings.  

  Last summer, this Committee asked NCI for “its expert opinion” on the estimated number of baseline cancers and radiation-related illnesses from nuclear weapons testing in the Republic of the Marshall Islands.  Our Division was tasked with developing this response because of our robust research program in radiation epidemiology, dose reconstruction, and risk estimation. 

  We developed unrefined estimates of radiation doses and numbers of radiation-induced cancers, based on: (1) measurements of Iodine-131 (I-131) in the urine of adults from two islands, Rongelap and Ailinginae, collected after the test BRAVO in 1954; (2) measurements of the contents of Cesium-137 (Cs-137) and other radionuclides in the body of inhabitants of Rongelap and of Utrik who returned to their atolls in 1954 and 1957; and (3) environmental measurement data on radionuclide deposition provided for all atolls by the Marshall Islands-sponsored radiological survey completed in 1994.  We combined these elements with a standard analytic approach to develop basic answers about cancer incidence.  This is, to our knowledge, the first time radiation doses and numbers of radiation-induced cancers have been estimated in a systematic manner over the entirety of the territory of the Marshall Islands.

  The NCI Director, Dr. Andrew von Eschenbach, sent his reply to this Committee with the following estimates:

  • About 5600 baseline cancer cases (i.e., those which are expected to occur, in the absence of exposure to fallout) may develop within the lifetime of the cohort alive during the test years 1946-1957, with an estimated population size of 13,940.  About half of those baseline cases, approximately 2800, have already occurred. 
  • In addition, about 500 cancers may develop as a result of exposure to fallout radiation.  Hence, exposure to fallout could result in about a 9 percent increase – to about 6100 – in the total number of fatal and nonfatal cancers expected.
  • We estimate that the thyroid gland was the most heavily exposed organ because it is the target organ for radioactive iodine, a major component of fallout. Of the estimated additional 500 fallout-related cancers, approximately 260 cases are expected to be thyroid cancer.
  • We expect that about 400 out of the estimated additional 500 radiation-related cancer cases will occur in the 35 percent of the population who were under 10 years old when exposed to fallout. Since members of this age group are now between ages 50-60, almost all of those cancers are likely to have occurred by the end of the next few decades.
  • Higher excess cancer rates are expected in the populations exposed to the highest doses that lived in the northern atolls. 

  Estimation of diseases other than cancer has not been made. Such work would require expertise and data not readily available in NCI.

  To obtain the cancer risk figures I have presented, three calculations had to be made:  we estimated doses, then baseline cancer rates, and derived radiation risks from epidemiologic studies of various irradiated populations.  It should be recognized that the estimated numbers of cancers to be expected are highly uncertain, because: (1) dose estimates are uncertain; (2) baseline cancer rates are approximate; and (3) organ-specific doses estimated for some atolls are so high that simple extrapolations based on the experiences of other irradiated populations, such as A-bomb survivors, may not be appropriate.  However, the doses were estimated so as to avoid significant under-estimation of the numbers of radiation-related cancers expected to occur. 

  I would like to bring to your attention the assumptions and uncertainties factored into our estimates:
  • In the absence of registry-based baseline cancer rates for the Republic of the Marshall Islands, the NCI Surveillance, Epidemiology and End Results Program (SEER)  rates representative of native Hawaiians were used as a surrogate. 
  • Dose models were developed in an unrefined fashion.  They are, however, based on our years of experience and understanding of radiation dosimetry and weapons fallout.  We used as input data all that were available to us, including monitoring data from the 1950s.
  • To present the best figures for this particular request, we made assumptions that likely have led to over-estimates of the average doses received and of the number of projected radiation-related cancers.  For example, we assumed a population size from the 1958 census, even though most of the exposure was received years before when the population is believed to have been smaller.  Lifetime cancer risks from radiation exposure were then estimated using risk projection models developed over many years at the NCI. 
  • While nearly one-third of the excess radiation-related cancers projected for the entire RMI could be attributed to cases on Rongelap and Ailinginae, we must emphasize that, because of the extremely high radiation doses received at those two atolls, current risk-projection models are likely to over-predict incidence.  Since lifetime risk is generally proportional to dose, the assessment of lifetime risk for persons who received particularly high doses generates an estimate that all such persons will develop a radiation-related disease.  Since we cannot say for certain that will be the case, the estimated numbers of radiation-related cancers over the whole nation should be treated as an upper limit of cases.

  As NCI wrote in its response to this Committee’s questions, there is a large library of published scientific literature and estimation tools, many of which we used to develop unrefined dose and risk estimates for the exposed populations.  What NCI did last summer was to perform the first dose-reconstruction for the entire Marshall Islands from available exposure data, and then develop risk assessment from mathematical tools not refined until 2003.  Nevertheless, there are a large number of uncertainties associated with our estimates, only some of which could be reduced in the framework of a comprehensive study.   In the long run, this would require a large, multidisciplinary effort undertaken over several years at considerable cost. The decision whether to move forward with such a study must be made with the understanding that the likelihood of reducing significantly the uncertainty regarding the total number of excess cancers is quite small.  The incremental information thus gained would be of little practical significance in terms of public health management in the Marshall Islands. The NCI, therefore, does not believe that a comprehensive study should be conducted.

   In the short term, NCI plans to submit the dosimetry and epidemiologic methods used to obtain this set of estimates to peer-review for publication in the scientific literature.  In this way, our work can be verified, refined, and employed by others who take an interest in the welfare of the Islanders. 

  I hope this information about the development of NCI’s estimates for baseline cancer incidence and radiation-related cancer risks in the population of the Marshall Islands has been helpful to you.  I would be pleased to answer your questions. 
   
   
   
  Estimated excess (radiation related) cancers by atoll group and organ
   Rongelap, Ailinginae Utrik Other northern atolls** Southern atolls Totals
  (number of baseline cancers in parentheses)
      Low exposure atolls*** Very low exposure atolls**** 
  Population size* 82 157 2005 3834 7862 13940
  Leukemia 1.5 0.61 2.1 0.44 0.27 5   (123)
  Thyroid 43† 46 132 26 15 262   (127)
  Stomach 8.4 1.4 4.4 0.69 0.37 15   (326)
  Colon 64† 31 49 9.2 4.0 157 (  470)
  Other cancers 31 8.5 39 8.6 5.9 93 (4550)
  All Cancers combined (rounded totals) 148†† 87 227 44 26 532 (5596)
         

  *Estimated from 1958 census (except for evacuated populations) as described in text.
  **Ailuk, Mejit, Likiep, Wotho, Wotje, Ujelang
  ***Lae, Kwajalein, Maloelap, Namu, Arno, Mili
  ****Lib, Aur, Ailinglaplap, Majuro, Ujae, Kili, Jaluit, Namorik, Ebon
  †Based on linear-model estimates applied to doses far higher than those in other studied populations, and therefore the estimate of excess cases is likely to be a rough upper bound (see text). This caveat is less applicable to estimates for Utrik, and does not apply to the other atolls (see Table 1 for average doses by atoll).
  ††Estimated number of cancers exceeds number of exposed

   

  
   

• Dr. Neal Palafox

  Read statement

  Witness Panel 1

  Dr. Neal Palafox

  STATEMENT OF NEAL A. PALAFOX, MD MPH
  PROFESSOR AND CHAIR
  DEPARTMENT OF FAMILY MEDICINE AND COMMUNITY HEALTH
  JOHN A. BURNS SCHOOL OF MEDICINE
  UNIVERSITY OF HAWAII
  TO THE SENATE ENERGY AND NATURAL RESOURCES COMMITTEE
  July 19, 2005

  Introduction

  The purpose of this testimony is to speak to the health consequences of the US Nuclear Weapons Testing Program (USNWTP) in the Republic of the Marshall Islands and the health system that is needed to address those consequences.  The current status of the health care services of the RMI and the medical programs designed for those who were adversely affected by the USNWTP (177 Health Program/ DOE Medical Program) will be discussed.  Finally, the cost and rationale for three health system solutions to address the varied health consequences of the nuclear weapons testing program will be presented. .

  Health Effects of the US Nuclear Weapons Testing Program

  Health, as defined by the World Health Organization (WHO), is “a state of complete physical, mental and social well being, and not merely the absence of disease or infirmity.”  The health consequences of USNWTP are acute medical conditions, chronic medical conditions, cultural impacts, mental health impacts, and social impacts.

  A holistic approach to health must be part of any discussion on health consequences of nuclear testing because “health” in nuclear testing is often distilled to ionizing radiation and cancers.  Health consequences of nuclear testing are a product of the bomb blast and the effect the process of testing had on the humans living in that environment. Utilizing a holistic approach is crucial in health care systems affecting indigenous Pacific populations.

  Cancers, hypothyroidism and thyroid nodules are clearly linked to ionizing radiation exposure.  The 2004 NCI report estimates 530 excess cancers from the USNWTP in the RMI. Half of the 530 excess cancers have yet to manifest themselves in the Marshall Islands population because of the length of time (latency) it takes for a cancer to manifest itself following the deleterious effects of ionizing radiation. 

  The latest scientific information on  the biological effects of low dose ionizing radiation 2005 BEIR VII report from the National Academy of Sciences adds that exposure to even extremely low doses of ionizing radiation may place individuals at a risk for cancer. BEIR VII also notes that intergenerational (hereditary) genetic effects may be possible in humans since intergenerational effects caused by ionizing radiation have been noted in mice and insects.

  Cultural and social disruptions from the USNWTP are associated with adverse health outcomes and illness.  Alienation from the land and critical natural resources through radioactive contamination or forced evacuation destroyed the physical and cultural means of sustaining and reproducing a self-sufficient way of life.  It also destroyed community integrity, traditional health practices and sociopolitical relationships.  Furthermore, community history and knowledge is destroyed when there is no lineage land from which to pass on knowledge about the local environment.

  Food supplementation became necessary for those who were displaced from their land and for those whose lands and food sources were contaminated with radiation.  For many years, the U.S. Government has provided USDA foods, mostly white rice and other processed foods, to the people of the four atolls.  Although some atoll communities are now using U.S. funding to purchase and ship their own foods rather than USDA foods, several adverse health impacts of USDA food supplements are evident in the recipient communities, as noted below:

  1. The natural diet has been altered.
  2. The available Western diet is high in fat, high in carbohydrates, low in fiber, and lacks Vitamin A and iron.
  3. There has been a loss of the cultural activities and norms surrounding food gathering and preparation.
  4. The loss of the physical activities surrounding food preparation has resulted in a more sedentary lifestyle.
  5. Diseases such as diabetes, atherosclerotic diseases, and hypertension have been exacerbated by the Westernized diet and more sedentary lifestyle.
  6. The industriousness and work ethic needed to prepare local foods from coral atolls with few natural resources has been stifled.
  7. Dependency on food supplementation has become a norm destroying the fabric of a once self-reliant community.

  Bodily harm is a tragedy that affects an individual for a finite period of time, whereas cultural destruction adversely affects the health of entire communities for generations. Cultural, mental and social impacts are difficult to quantify and measure and so it becomes easy to pretend they do not exist.  The cancer burden that was generated from the nuclear testing program was quantified by the NCI 50 years after the insult. Other health consequences will likely be quantified soon.   

  
  Health Care Environment and Services in the RMI

  RMI Ministry of Health and Environment

  The present health care environment of the Republic of the Marshall Islands is brittle.  Many unnecessary illnesses and deaths occur because the health care system cannot systematically respond to the health needs of the people. The health situation will get worse as the population expands, as the proportion of elderly increases, as the burden of costly chronic illnesses grows, and as the limited health dollars and finances wane.  The infant mortality rate is 3-4 times that of the US, and the longevity of Marshallese is 12 years less than people in the US. Hansen’s disease (leprosy) and TB are commonplace.

  The 15-year RMI Strategic Health Plan (2001-2015) describes a health system that is not financially sustainable with its present resources. According to the RMI Health Plan, the Ministry of Health is projected to lose an equivalent of $21 million dollars in services over the next 15 years under present funding and levels of health care. The RMI pays nearly $2 million dollars a year, a significant portion of all its annual health expenditures, for medical cases sent out of the country for treatment because of lack of health infrastructure.  The monies spent in referral health centers abroad are not directed towards the RMI health infrastructure.

  Compact funds are the primary source of healthcare dollars and resources. Funding from the Compact represents nearly half of the Gross National Product of the RMI and 40% of all health care funding (direct Compact funds, Section 177 funds, US Federal Grants) in the RMI. Another 23% of the health care dollars have been derived from the RMI General Fund. Less than 1 % of health dollars has been derived from local user fees.

  The total amount of all the sources of health revenue for fiscal year 2005 is about $14 million dollars. As a comparison, the Commonwealth of the Northern Marianas is struggling with an annual health budget of $45 million annually. The populations of these two Pacific countries are similar, 55 thousand people.

  The 2004-2005 Budget Portfolio of the RMI Health Services describes some changes in health allocations with the amended Compact. There is now a Ebeye Special Needs fund in the amount of $3.1 million of which $1.5 million is allocated to the Ebeye hospital. While this special fund is being added to the health care budget, the amount for the 177 Health Program has decreased by 1 million annually.  On balance there has been a modest gain in finance.

  In Majuro Hospital there are sometimes no oxygen supplies for the operating room and critical patients, there are no reagents for many simple laboratory tests, and there are no biopsy needles for examination of common cancers. Renal failure is commonplace because of high rates of diabetes, yet there is no dialysis unit in the RMI.

  Federally Funded Medical Programs for Marshallese affected by the USNWTP

  There are two Medical care programs for people affected by the USNWTP, the DOE Medical Program and the 177 Health Program. 

   

  
  DOE Program

  Section 103(h) of the Compact “provide(s) special medical care and logistical support” to the populations present on Rongelap and Utrik during the Bravo test on March 1, 1954.  The Department of Energy program also provides medical care to a comparison population.  Members of the comparison group were not exposed to the Bravo fallout in 1954.  However, they were resettled on Rongelap with the Bravo victims at a time when radiation contamination of the atoll was still an issue.

  Between the mid 1950’s until 1997, Brookhaven National Laboratory (BNL) was contracted by the DOE (for $1.1 million annually) to provide medical care to those exposed to the Bravo detonation and to the comparison group.  BNL healthcare consisted of monitoring and treating the designated population for radiogenic illnesses on a biannual basis.

  From 1998 to 2004, the RMI and the DOE jointly developed a more comprehensive health care program for the USNWTP affected population. Clinics on Kwajalein and Majuro were established to deliver year round healthcare and adjunct programs were instituted to develop the health capacity and infrastructure of the RMI.

  In 2005, the DOE redirected the medical program towards focusing largely on cancer care. Capacity building with the RMI Ministry of Health and more comprehensive health care elements for the affected population are now being eliminated.

  The funding for the program participants is adequate; however utilization of health services is limited by the design of the program. Funding for this program could be used more effectively in the RMI for maintaining the primary care services, capacity building, as well as the cancer care aspects of the program.

  177 Health Care Program

  The 177 Health Care Program provided in the 177 Agreement is designed to provide primary, secondary and tertiary medical services to the people of Enewetak, Bikini, Rongelap and Utrik islands who were affected by the USNWTP.  This includes most of the people enrolled in the DOE medical program.  The 177 Health Care Program’s design was developed through the US Public Health Service (USPHS) in 1985.  The design of the program by the USPHS is laudable, having essential elements of primary, secondary and tertiary medical care.  However, delivery of what was proposed by the USPHS has been impossible because of limitations in funding and the RMI health care infrastructure.

  The chart below illustrates the cost per person per month (PPPM) to achieve basic levels of primary, secondary and tertiary health care in the United States as compared to the 177 Health Care Program.  These figures, calculated by Mercy International, are based on 1997 Health Care Dollars and do not reflect increased health care costs during the past seven years.

   PROGRAM    (PPPM)

   U.S.
   Commercial Population   $135
   Medicare (Nebraska)   $221
   Medicare (New York)   $767
   Medicaid (Michigan)   $120
   HCFA     $293

   RMI
   Section 177     $13.60*

  *The PPPM for the RMI is calculated as follows:  $2 million dollars annually, divided by 12,259 patients, divided by 12 months equals $13.60 PPPM.

  The funding for the 177 program in 2005 has dropped from 2 million annually to 1 million annually. In 2003, the program operated only on $500,000.  Each fiscal year the tertiary care budget for 177 patients is consumed within the first three months.

  
  RMI Ability to Address the Health Care Consequences of the USNWTP

  The ability for health services in the RMI to systematically address the daily medical encounters is limited. The RMI health system, although improving, struggles to provide adequate routine health care for its citizens. The 177 program is severely under funded and contributes modestly to the overall health care needs of the 177 participants. The DOE program is adequately funded for its patient base and present mandates, however, the program design lacks comprehensive care and lacks a proactive stance towards building the capacity of health services. 

  Cancer

  There were 530 excess cases of cancer generated by the USNWTP. Is the present RMI Health Services able to care for the burden of cancer?  From October 1, 2004 through  June 6, 2005 there were 26 Marshallese patients with cancer who were presented to the medical referral  committee which determines if they would benefit from off-island referral to a tertiary care center. Eleven of the 26 cases were denied referral because the cancers were too far advanced.

  Far advanced cases suggest that the health system is unable to provide timely screening, early medical interventions and that the patients are not aware of their risks and conditions There is no mammography unit to detect breast cancer or colonoscope to detect colon cancer in Ebeye, no operational CT scanner in the RMI, and no operational dermatome in the lab to process cancer specimens. When there is no medical oxygen in the hospital due to medical equipment problems, major surgery, which many cancer patients require, is not an option. And if the oxygen does arrive, there is no way to process the specimen without a dermatome. 

  The fact that 26 cancer patients were referred suggests that necessary medical care could not be provided in the RMI. Chemotherapy is not given in the RMI because of deficiencies in qualified laboratory, nursing and pharmacy staff.

  Comprehensive cancer care requires local health systems to address prevention, screening, biopsies. pathology services, surgical expertise, intensive unit care, chemotherapy expertise, scanners, lab support, palliative care and issues of survivorship and quality of life. None of these systems are fully operational, and some are non-existent.  In 2003, only 9% of women who were in the age category to receive cervical PAP smears (to screen for cervical cancer) actually received a PAP smear. There is neither an oncologist nor a cancer registry in the RMI.
  Tthe inability to handle difficult medical problems, such as cancer, places a burden on surrounding areas that have cancer services.  Many of the folks who are not supported by the RMI health system as a referral find their way to Hawaii or Guam, and enter the medical systems there. These patients have no resources for the very expensive cancer care in Hawaii and or Guam.  Although all RMI medical debts have now been paid, in the past there has been difficulty keeping up with payments because of a lack of RMI funds. Such interactions place a strain on the good will and medical / business relationships of the RMI, Hawaii and Guam. 

  Building a health care system for cancer: (system 1)

  The costs of a health system to care for cancer patients are dependent on the answer to several questions which will determine the system design.

  1. What is standard of health care that we are trying to provide? Are we building a US level of health care system and facility or designing a different type of system?
  2. What standard of health care will be provided to cancer patients with other illnesses (diabetes, heart disease, high blood pressure, asthma, complications from treatment)?
  3. Can all services/ components be sustained in the RMI or will some services/components to be provided at another center or site?
  4. How many cancer patients will be treated?
  5. Should the patients deserve to have most of the cancer care in their home environments?
  6. Over what period of time will the system need to be intact?
  7. Is the objective to build the capacity of the RMI to care for cancer patients?
   
  The components of a comprehensive cancer care system are well known. 

  Data tracking including a cancer registry, medical records
  Screening  (mammography, colonosocopy , colposcopy, ultrasound)
  Diagnostic testing (CT scanning, x-ray, laboratory tests)
  Treatment  (surgical intervention, chemotherapy, pharmaceuticals, radio-therapy)
  Medical support (intensive care, nursing, transfusion, antibiotic support, pain management)
  Prosthesis support
  Social services and health education services
  Administrative support

  Comprehensive cancer care requires access to high functioning primary, secondary and tertiary health systems.

  Costs:

  Using the following assumptions:

  1. That a US Standard of care be provided for the cancer patients because the USNWTP caused the excess cancer rates.
  2. That the system is capable of providing a US Standard of health care for other  health problems in cancer patients, especially at the time of cancer treatment. 
  3. That the system will provide comprehensive cancer services, with some specialized needs being met in Hawaii or other tertiary health care sites.
  4. That there will be a minimum of 265 (.5 times 530) cancers resulting from nuclear testing and some 2800 (.5 times background 5600 cancers) over the next 30 years as extrapolated from the 2004 NCI report. The 265 excess cancers will be indistinguishable from cancers which have occurred as part of the background cancer rate.
  5. That an appropriate system of cancer care would deliver as much care as possible in Majuro and Ebeye.
  6. That capacity building is the best approach as it is one of the objectives of the amended Compact and makes the most economic and developmental sense.

  The comprehensive cancer care system requires an intact primary care system, screening system, cancer registry, mammography, colonoscopy, medical laboratory, pharmacy, surgical capabilities, intensive medical care capabilities, supplies, prosthesis,  pharmaceutical, CT scanner,  x-ray unit, ultrasound, and the medical expertise to staff and run the system.  A sophisticated hospital is needed with these capabilities.  In the RMI adequate screening should be available to the people of the outer islands. They should be brought to the urban hospitals to get recommended cancer screening.

  The facilities, infrastructure, and manpower required to provide comprehensive cancer care, and provide the medical care of cancer patients who are suffering from other illnesses during times of cancer care will be significant. The recurrent operations costs for such a 10 acute bed facility at the base cost of about $1300 / acute bed / day would be about 5 million dollars annually. Kwajalein Military Hospital (USAKA) has 11 acute beds and the annual budget is about $5.5 million.

  The outer island screening and primary care as well as the specialty referral services to Hawaii would be another 2.5 million dollars in cost annually.

  The total operations health care costs for a comprehensive cancer system would be in the order of 8 million dollars annually. Capital costs would be in the order of 6 million dollars. Notably, a separate cancer facility and cancer system would have to be built to make this system functional. Adding 8 million dollars to the existing RMI system would dilute the effort and not allow the comprehensive cancer system to reach a US standard of health care. 

  177 Health Care System (system 2):

  The 177 Health Care program serves about 14,000 Marshallese. The 177 Program was designed to provide primary (prevention), secondary (hospital), and tertiary (referral) care for the program participants. It is unfortunate that the level of funding did not support the program design to any reasonable standard of care. Assuming a US Standard of Health Care System to provide primary, secondary, and tertiary care would cost about 50 million dollars ($300 per person per month X 12 months x 14,000 participants) annually.

  The four atoll membership bears the largest proportion of cancers that was generated from the USNWTP. Except for the DOE subset of patients (200 people), the remaining 14,000 program participants have no better access to adequate cancer screening, treatment, and services than the rest of the RMI patients. The 177 members should have US Standard cancer health services.

  The 177 Program in particular suffers from the difficulty of quantifying social, cultural and mental health impacts.  Caring for the participants with a 50 million dollar primary, secondary, and tertiary health care system would address cancer and the other health consequences for this population.   

  Economy of Scale (system 3):

  Building a comprehensive cancer health system, providing a high standard of health care for the 177 health care recipients, and managing the DOE Medical Program can be done for an operations cost of 45 -50 million annually. The system and facilities that would be constructed would have the absorptive capacity to provide a high level of health care for the RMI, in general. The Common Wealth of the Northern Marianas, which supports a similar population to the RMI (55,000 people), has an annual operations budget of 45 million dollars annually. Capital costs would be in the order of 50 million dollars.

  Building such a system could provide comprehensive cancer care to all Marshallese while meeting their comprehensive health care needs. The NCI report suggests that the ionizing radiation which caused cancers reached beyond the four atolls and even beyond the northern atolls of the Marshall Islands. The lack of a defined boundary of who was affected and who was not affected by nuclear fallout makes a nation-wide system ideal.

  A program which provides high standard comprehensive health care for all Marshallese would address the health consequences of the USNWTP in a cost effective, capacity building manner. This system would also address the health care needs of over 300 Marshallese and other indigenous Pacific islanders who participated in the clean-up of Bikini and Enewetak atolls who live in the RMI. This subgroup has little access to extra health care services. 

  Conclusion:

  Developing a health care system to address the health consequences of the USNWTP in the RMI is related to the illness(es) that must be addressed, the burden of that illness, and the standard of care to be applied for that illness.

  The cancer burden has been clearly defined by the NCI. Other health consequences are more difficult to quantify or have yet to show themselves (genetic effects).  All three systems of health above are structured to address the cancer burden in the RMI. The 177 Program and the economy of scale program, as defined above, are designed to address the cancer burden and the other health effects of nuclear testing.  

   

• Gerald Zackios

  The Honorable

  Read statement

  Witness Panel 1

  Gerald Zackios

  STATEMENT OF THE HONORABLE GERALD M. ZACKIOS,
  MINISTER OF FOREIGN AFFAIRS,
  REPUBLIC OF THE MARSHALL ISLANDS,
  TO THE SENATE ENERGY AND NATURAL RESOURCES COMMITTEE
  July 19, 2005

  Mr. Chairman, Distinguished Members, Ladies and Gentlemen:

  With me here today are two Cabinet Members from President Kessai H. Note’s administration, Alvin T. Jacklick, the Minister of Health, and Donald F. Capelle, the Minister of Justice.  I also want to recognize our traditional leaders, Senators, Mayors, and citizens from the Marshall Islands in attendance today – the distance, time, and expense that it took for these people to join us underscores how important nuclear issues are to communities throughout the RMI. 

  The Government of the Republic of the Marshall Islands thanks the Committee for convening a hearing to examine the legacy of the U.S. nuclear weapons testing program in the RMI, and to consider the RMI’s Changed Circumstances Petition (CCP) to Congress.  As you are aware, in the 177 Agreement of the Compact of Free Association, Congress gave the RMI the right to petition Congress for additional assistance related to the nuclear weapons testing program if it can demonstrate that:
   1.)  it has new and additional information about the damages and injuries from the  testing program;
  2.)  this information could not have been reasonably known when the RMI and the U.S. negotiated the Compact, and;
   3.)  this information renders the $150 million settlement for all past, present and
   future damages and injuries manifestly inadequate.

  The RMI government believes it has met these criteria for changed circumstances and looks to you, the Congress, to respond to our requests for additional assistance to address the enduring radiological problems resulting from the U.S. testing of 67 atmospheric weapons in our nation between 1946-1958.

  The 4 atolls and other populations require continued and new U.S. assistance
  My testimony does not provide a history of the U.S. nuclear weapons testing program because I believe that is a matter of Congressional record from previous hearings, but I do want to emphasize that what we now know -- and did not know when the 177 Agreement was negotiated -- is that more people and islands in the RMI were exposed to significant radiation than was understood when the Compact was negotiated, and that smaller doses of radiation cause more harm than previously believed.  The U.S. government position regarding radiation-related damages and injuries is based on the premise that only 4 atolls were adversely affected by the testing program, and that only the 2 populations of Rongelap and Utrik were exposed to levels of radiation sufficient to warrant medical monitoring and care.  When we look at the cumulative levels of radiation exposure from as many of the 67 tests that we have radiological exposure data for, we see significant exposure to people and islands beyond the confines of the 4 atolls.  These radiation levels are higher in the north where populations suffered the brunt of damages and injuries, but radiation levels are significant for other atolls throughout the nation. 

  As stated in my testimony last month to the House Resources Committee and the Subcommittee on Asia and Pacific of the House International Relations Committee, we are confident that we have met the requirements for changed circumstances and we are anxious to hear Congress’ reactions to our petition.  I would like to ask that my testimony to the House be included as part of this hearing record so we can build on that discussion. 
  We believe the House hearing established that radiation exposures allowable under U.S. standards have been significantly reduced since the Compact came into effect, and that the RMI should expect hundreds of cancers to appear in the future for Marshallese alive during the testing program.  We want to thank this Committee for requesting the National Cancer Institute’s report on future cancer rates in the RMI related to the U.S. nuclear weapons testing program, as the RMI lacks the resources to undertake this type of analysis.

  An unequaled strategic partnership
  As you know, all of what we are discussing today takes place in the context of the RMI’s longstanding commitment to its strategic partnership and historical friendship with the United States.  The RMI is extremely proud of the role it played in contributing to the end of the Cold War, despite its radiological burdens.  We are thankful that America’s nuclear deterrence has curtailed the global use of nuclear weapons.

  Today, the RMI is pleased to be a partner with the U.S. in the development and testing of its missile defense systems on Kwajalein Atoll, which will hopefully reduce the likelihood of any future missile attacks.  In addition, we know that our consent to the U.S. Navy’s use of our airspace and sea lanes helps promote security in the Asia-Pacific region.

  The RMI is extremely proud, too, of its sons and daughters who currently serve in every branch of the U.S. armed forces and are deployed in both Iraq and Afghanistan.  Our commitment to you as a strategic ally goes beyond words; we have contributed our most precious and sacred resources: our sovereign lands, our territorial waters, and – most importantly – our young men and women. 

  House Concurrent Resolution 410, adopted by the Senate on July 12, 2004, makes specific reference to our unique, enduring, and strong bilateral relationship, and notes:

   Whereas the United States has no closer alliance with any nation or group of  nations than it does with the Republic of the Marshall Islands under the Compact  of Free Association, which continues the strategic partnership and role of the  Marshall Islands in United States strategic programs based in the Marshall  Islands, which began at the end of World War II and has continued under the  trusteeship and Compact to promote the mutual security of the United States and  the Marshall Islands…

   Whereas the Republic of the Marshall Islands has remained one of the staunchest  allies of the United States during the cold war and the war on terrorism, and the  voting record of the Republic of the Marshall Islands as a member state in the  United Nations General Assembly is unparalleled by any other country, further  demonstrating the shared commitment of the two nations to promote democracy  and global peace[.]

  Given the subject of H. Con. Res. 410, I would like to ask that it be included in its entirety as part of this hearing record.  We seek your continued partnership to cope with the serious problems that remain as a result of the U.S. nuclear weapons testing program in our country. 

  Specific requests to the U.S. Congress
  In the Petition to Congress, the RMI government laid out specific requests for remedies to address the on-going radiological burdens that are a direct result of the U.S. nuclear weapons testing program.  We ask for your assistance to address these damages and injuries because we lack the human and financial resources to provide the remedies that are required.  Although the RMI government has proposed specific remedies, we are certainly willing to explore any ideas that will bring relief from our radiological burdens.  Our specific requests to Congress are:

  1. $15.7 million so the Nuclear Claims Tribunal can pay existing personal injury awards.
  As of December 31, 2004, 45% of personal injury awardees with radiological illnesses have died without receiving full compensation for their injuries because the Tribunal does not have sufficient funding to pay the full amount of its awards.  $15.7 million represents the shortfall in funds to pay current awards.  In the case of the program for U.S. Downwinders, the Attorney General requires that 100% of compensation be paid within 6 weeks of the time an award is made.  The RMI agreed to the 177 Agreement of the Compact of Free Association because it provides compensation for the people of the Marshall Islands who contract radiological illnesses.  The Nuclear Claims Tribunal created a compensation program based on U.S. programs for Downwinders and Veterans exposed to radiation, but the Tribunal’s program is unique because the people of the Marshall Islands were exposed to more radiation than any other population in the world.  As the U.S. National Cancer Institute recently noted in its report to Congress, “[m]ost of our understanding of the biological response to radiation exposure pertains to doses that are much lower than those of the more highly exposed Marshallese…” such as the Hiroshima and Nagasaki A-bomb survivors. 

  2.  Replenish the Nuclear Claims Trust Fund so the Nuclear Claims Tribunal can continue to make personal injury awards in the future. 
  The preceding shortfall from request number 1 represents the current balance on personal injury awards as of June 24, 2005, and does not take into consideration the U.S. National Cancer Institute’s prediction of several hundred more radiation-related cancers in the future.  The RMI government believes that the Nuclear Claims Trust Fund needs to be replenished to provide compensation for future radiation-related injuries -- such as the cancers the NCI has told us to expect -- as the intent of the 177 Agreement is for the Tribunal to create and maintain, in perpetuity, a means to address past, present and future consequences of the nuclear weapons testing program.  The intent of the 177 Agreement is for the Tribunal to have the future means to pay awards for personal injury but the Tribunal does not have funding to make the future awards agreed to in the 177 Agreement.   

  3.  $1.1 billion so the Nuclear Claims Tribunal can pay for the Enewetak and Bikini private property awards. 
  Like the personal injury awards, the 177 Agreement provides for claimants to receive compensation for private property damages.  Since the Tribunal funding is manifestly inadequate and the Tribunal does not have the ability to pay for awards it has made, the intent of the 177 Agreement has not come to fruition.  Recognizing that the dollar amounts needed for the private property claims are quite high, the RMI would welcome consideration by Congress to moving the land claims to the U.S. federal courts to review the decisions and the right of claimants to receive awards.  It is important to note that the funding of private property awards would enable affected Marshallese to rid their land of radiological contamination, rehabilitate the soil, re-vegetate the land, resettle their home islands, and provide the means to establish a local economy in the fishing and tourism sectors.  Thus, the funding would provide the affected communities with the means to return to self-reliance.

  4.  Establishment of similar consideration for future private property claims.
  The RMI also requests that a similar mechanism to request number 3 be adopted for pending private property claims.  The Tribunal is expected to rule on several private property claims in the near future for atolls such as Rongelap, Utrik, Ailuk, Likiep, and others.  Private property claims will become meaningless if the Tribunal is unable to pay out its rewards.   

  5.  $50 million to build adequate infrastructure for the delivery of radiation-related healthcare. 
  The RMI currently lacks the infrastructure to respond to radiation-related illnesses.  We believe that infrastructure is a critical component of building the RMI’s capacity to address its radiation-related healthcare needs.  We envision a scenario where we establish facilities and services that are reasonable to provide in the RMI, including the ability to monitor exposed populations, diagnose radiological illnesses, and provide treatment for most conditions.  When it is not cost effective or practical to provide treatment in the RMI we would like to send our patients to Hawaii to purchase the care we cannot reasonably provide. 

  6.  $45 million each year for 50 years to provide healthcare delivery. 
  Once infrastructure is in place, the RMI needs funding to hire doctors, purchase medication and some services in Hawaii, and to deliver healthcare for patients exposed to radiation.  Building the healthcare capacity of the RMI will benefit Marshallese citizens exposed to radiation and provide the capacity to deliver more timely care for radiation-related illnesses, with the hope of identifying medical problems when they are still treatable (before they reach the tertiary stage) and extending the lives of the patients. 

  7.  Assignment for the monitoring of the Runit Dome to a U.S. agency. 
  The portion of the Enewetak population that has resettled one of its home islands needs assurances that its health is not adversely affected by living adjacent to a nuclear waste storage facility.  Currently, no U.S. agency has responsibility to monitor the integrity of the Runit Dome. The Defense Nuclear Agency used to have responsibility for this work, but the agency was abolished and responsibility for the Runit Dome was not transferred to another agency. 

  Focus on the Nuclear Claims Tribunal and healthcare needs
  Our requests obviously focus on the Nuclear Claims Tribunal and radiation-related healthcare needs.  It is appropriate for the RMI to focus two of its major requests on the Tribunal.  In lieu of an assessment of damages by the Federal courts, the RMI government accepted the U.S. proposal that it espouse and settle the claims of the Marshallese people arising from the nuclear weapons testing program in conjunction with the establishment of a claims tribunal.  The U.S. expressly recognized that its technical assessment of radiological damage to persons and private property in the RMI was limited to a “best effort” at the time of the Compact, and was based on limited disclosure of available information and incomplete scientific knowledge.  As a result, further adjudication of claims by an internal RMI nuclear claims tribunal was agreed to by the U.S. 

  During the U.S. nuclear testing program from 1946 to 1958, the U.S. was the only recognized government in the Marshall Islands.  The U.S. federal government exercised absolute power, including eminent domain, by federal edict.  The federal government  took the private property of our people without legal or political restraint.  The right of our people to protection under the 5th Amendment of the U.S. Constitution was not recognized in the U.S. federal courts until after the nuclear tests were done.
   
  Some of our homelands were destroyed forever, vaporized in land, air and water-based nuclear tests.  Some are still too contaminated for resettlement.  The loss and damage to land, the dislocation of peoples, the cost of clean-up and resettlement, were only partially compensated through the Nuclear Claims Trust Fund.  Full and just compensation was promised by Congress in the Compact, but could not be quantified until the land claims were adjudicated by the Nuclear Claims Tribunal.
   
  Under the Compact, Congress removed our claims from the federal courts, and the Nuclear Claims Tribunal was created as an alternative forum for just compensation.  The awards of the Tribunal are substantially greater than the compensation that has been paid.  The U.S. refused to discuss this problem during the Compact renegotiations.  This is a legal matter, not just a political question.  For that reason, the RMI and the land claimants propose that the Tribunal awards be reviewed by the federal courts in the same manner as judgments of RMI courts against the U.S. under Compact Section 174(c).

  The RMI government appears before you today to inform you that the Nuclear Claims Tribunal in the RMI is not able to perform the role that Congress intended because of inadequate funding.  The independent assessment of the Tribunal made by former U.S. Attorney General Richard Thornburgh in 2003 confirmed that the Tribunal adhered to American standards of jurisprudence, and concluded that the funding available to compensate for private property damage and personal injury is “manifestly inadequate.”  I would like to enter the executive summary of the Thornburgh report as part of this hearing record.  I would also like to note that Congress has provided additional appropriations for U.S. Downwinders and DOE employees when supplemental funding was needed to make awards for claimants. 

  The RMI has also focused on healthcare delivery because this is an area where an urgent need exists.  People in the RMI with radiological conditions are dying.  We are certainly appreciative of the DOE medical monitoring and care program for a small segment of our population, and for the U.S. contributions to the 177 Health Care Program for the 4 atolls.  I would also like to thank this Committee for referring these issues to the Appropriations Committee, and to Mr. Domenici and Mr. Burns for their leadership on that Committee, and hope that they will support full funding this year in conference with the House.  However, despite our best intentions to date, these programs do not address the full range of radiological healthcare burdens in the RMI. 

  One of the measures adopted under the Section 177 Agreement to compensate the people and government of the Marshall Islands was a healthcare program for 4 of the atoll populations impacted by the testing program, including those who were downwind from one or more test, and the awardees of the personal injury claims from the Tribunal who manifest radiation-related illnesses in their tertiary phases.  The medical surveillance and healthcare program established under the Section 177 Agreement has proven to be manifestly inadequate given the healthcare needs of the affected communities. 

  The 177 Health Care Program -- the only other radiation-related healthcare program besides the DOE program for less than 120 acutely exposed patients from Rongelap and Utrik -- was asked to deliver appropriate healthcare services within an RMI health infrastructure that was not prepared or equipped to deliver the necessary level of healthcare.  The program's funding -- $2 million per year for 17 years (from January 1987 to January 2004), and $500,000 for February to September 2004, was drawn down from the Nuclear Claims Fund provided by the U.S. in fulfillment of its commitment under the 177 Agreement.  This program never included an inflation adjustment, and resulted in the equivalent of less than $12 per patient per month compared to an average U.S. expenditure of $230 per person per month for similar services.  The unstable and inadequate funding in recent years creates a healthcare crisis for our nation, particularly at a time when the people alive during the testing program are becoming older and are more likely to develop or have significant radiation-related illnesses, such as the cancers that the NCI study reports. 

  An example of a population that slipped through the cracks of U.S. assistance include the 401 people residing on Ailuk Atoll during the Bravo test on March 1, 1954 -- a population that U.S. government documents concede should have been evacuated after the Bravo test because of significant exposure to radiation.  The U.S. government decided not to evacuate the Ailukese because its population -- almost 4 times as large as the evacuated population from Utrik -- was considered too large and cumbersome to relocate.  Consequently, the people of Ailuk have never been eligible for medical monitoring and care, and the residents of that atoll continued to live in a highly contaminated environment after the Bravo test, while the downwind populations of Rongelap and Utrik were evacuated by the U.S. government.  I would like to request that the U.S. government document regarding Ailuk’s evacuation post-Bravo be included as part of the hearing record. 

  Similar cases can be made for other atoll populations alive during the testing program (such as exposure levels on Kwajalein included in the RMI’s CCP), for those born and raised in radiologically contaminated environments, and for workers from atolls all over the Marshall Islands and who worked as DOE contractors to support clean-up efforts on Bikini and Enewetak.  This latter group is not eligible for U.S. compensation or healthcare programs for DOE workers exposed to occupational sources of radiation as part of the Energy Employees Occupational Illness Compensation Act (EEOICPA) because they are not U.S. citizens.  In this regard, we want to thank Mr. Bingaman for including the Marshall Islands in the list of locations where DOE workers exposed to radiation could receive medical care and compensation.  The interpretation of the Executive Branch is that non-Americans – such as former citizens of the U.S. trust territory – are not eligible for the program because they are not U.S. citizens.  We request that citizens of the former U.S. trust territory employed by DOE be eligible for inclusion in this program since neither funding nor healthcare are available to these workers through other means. 

  The RMI lacks the ability to provide the healthcare that is warranted for the populations exposed to radiation.  During the May, 2005 joint hearing of the House Resources Committee and the Subcommittee on Asia and Pacific of the House International Relations Committee, the National Cancer Institute representative told us that the RMI should anticipate hundreds more radiation-related cancers in the future -- these are cancers that would not exist in the RMI if the U.S. nuclear weapons testing program did not take place.  As we told the House committees, this news is devastating to the RMI as we lack the infrastructure, and the human and financial resources to respond to these cancers.  Every family in the RMI has a first-hand understanding of the pain and suffering cancer patients and their loved ones endure, so it is difficult for us -- even from an emotional standpoint -- to anticipate several hundred more cancers linked to the testing program.  We thought most of the healthcare burdens were behind us, but it is clear that we now need to adjust our thinking and plan for the future.  The NCI also tells us that these cancers will not be limited to just the 4 atolls, yet the 4 atolls are the only populations in the RMI that receive any radiation-related healthcare.  All of our citizens who contract cancers will need healthcare -- healthcare that we are currently unable to provide.

  
  Provisions of the Compact, as amended
  During the House hearing in May, witnesses from the U. S. Administration suggested that the RMI had the ability to deal with healthcare or other issues arising from the nuclear testing program by allocating a portion of its Compact sector health care grants for these needs.   First, as I noted during the House hearing, this suggestion is contrary to the position taken by the Administration during the amended Compact negotiations.  During those negotiations, the Administration was adamant that issues concerning residual problems relating to the Section 177 Agreement would not be addressed during those talks despite efforts by the RMI to raise these issues at that time.  This is evidenced by U.S. Compact Negotiator Al Short’s letter to me dated March 27, 2002, stating the Administration’s position on the matter.  I would like to include that letter as part of the hearing record.  As noted in that letter, the RMI was told that these issues would be considered and dealt with by the Congress under the Changed Circumstances Petition that was pending at that time. 

  Thus, it is clear from the record that the amended Compact does not take into account or include funding necessary to address the healthcare or other continuing needs of the RMI to address the ongoing consequences of the nuclear testing program.  If the RMI were to allocate funds necessary to address these issues from funds available under the Compact, as amended, it would result in a substantial reduction in other essential healthcare services to the people of the Marshall Islands and would also adversely affect other priority Compact sector grant assistance such as education. 

  The RMI was told that issues related to the consequences of the nuclear testing program would be addressed by the U.S. Congress within the framework of the changed circumstances petition as authorized by Article IX of the Section 177 Agreement, which is why we are here before you today.

  Changed Circumstances continue to emerge
  Between the House hearing in May and today’s hearing still more information about the health effects of radiation exposure has come to light -- information that represents changed circumstances because it was unknown when the U.S. and the RMI negotiated the Compact of Free Association and the 177 Agreement.  This new information renders past assistance manifestly inadequate, since that assistance does not include healthcare designed to address these newly identified needs.  Specifically, there is a new study from the National Academy of Sciences (NAS) about the effects of low doses of radiation, including an important discussion about cancer risks for women and children.  The Biological Effects of Ionizing Radiation (BEIR) series of reports by the NAS are regarded as the most authoritative basis for radiation risk estimation and radiation protection regulations in the United States. 

  The latest report on radiation risk, called the BEIR VII report, was sponsored by the U.S. departments of Defense, Energy, and Homeland Security, the U.S. Nuclear Regulatory Commission, and the U.S. Environmental Protection Agency, and concludes that low levels of exposure to ionizing radiation may cause harm in human beings and are likely to pose some risk of adverse health effects.  The report specifically focuses on low-dose, low-LET -- "linear energy transfer" -- ionizing radiation that can cause DNA damage and eventually lead to cancers, and calls for further research to determine whether low doses of radiation may cause other health problems, such as heart disease and stroke, which can occur with high doses of low-LET radiation.  What is most clear from the review of available data is that the smallest dose of low-level ionizing radiation has the potential to cause an increase in health risks to humans.  As stated by the chairman for the report, Richard R. Monson, associate dean for professional education and professor of epidemiology, Harvard School of Public Health:

   The scientific research base shows that there is no threshold of exposure below  which low levels of ionizing radiation can be demonstrated to be harmless or  beneficial… The health risks – particularly the development of solid cancers in  organs – rise proportionally with exposure.  At low doses of radiation, the risk of  inducing solid cancers is very small.  As the overall lifetime exposure increases,  so does the risk.

  This finding is extremely significant to the RMI as everyone alive during the testing program was exposed to radiation from the 67 atmospheric tests, and thousands more people were exposed to environmental sources of radiation when they were born and/or raised on radiological contaminated islands.

  Interestingly, survivors of atomic bombings in Hiroshima and Nagasaki, Japan, were the primary sources of data to estimate the risks of most solid cancers and leukemia from exposure to ionizing radiation, yet the U.S. National Cancer Institute acknowledges that because radiation exposure in the RMI exceeds other locations, exposure and outcomes in the RMI cannot be compared to other locations such as Japan.  We are left to conclude, therefore, that any findings in the Japanese population are likely exacerbated in the RMI.  The BEIR VII report is also important because it notes that adverse hereditary health effects that could be attributed to radiation have not been found in studies of children whose parents were exposed to radiation from the atomic bombs in Japan, but studies of mice and other organisms have produced extensive data showing that radiation-induced cell mutations in sperm and eggs can be passed on to offspring.  The report states that there is no reason to believe that such mutations could not also be passed on to human offspring, as the failure to observe such effects in Hiroshima and Nagasaki probably reflects an insufficiently large survivor population.

  The BEIR VII report also updates the risk of dying from cancer for women and men, and for children compared to adults.  According to the report, the risk of dying from cancer due to radiation exposure was believed in 1990 to be 5% higher for women compared to men; this latest report now updates the risk to 37.5% higher for women than for men.  Furthermore, the risks for all solid tumors, like lung, breast, and prostate, added together are almost 50 percent greater for women than men. 
   
  The BEIR VII report estimates that the differential risk for children is even greater.  For instance, the same radiation in the first year of life for boys produces three to four times the cancer risk as exposure between the ages of 20 and 50.  Female infants have almost double the risk as male infants.  This information is obviously of concern to us, and we seek the assistance of the U.S. government to apply these findings to the Marshallese context.

  Looking for equity
  The RMI is in a very precarious position.  We have very significant radiological burdens in the RMI that we lack the resources, knowledge, or capacity to address.  These radiological burdens -- including the need to clean-up private property and return populations to their home islands, and the need to provide adequate healthcare and monitoring to all communities exposed to significant levels of radiation -- are expensive.  Despite the costs of remedies, we are simply asking the U.S. government for the same assistance, services, and compensation that it extends to its own citizens exposed to radiation or whose private property is contaminated.  

  The RMI is extremely worried about the well-being of the people in the Marshall Islands who were exposed to radiation from the 67 atmospheric atomic and thermonuclear weapons tests in the RMI, as well as the populations resettled on contaminated islands, including children who were born and raised in environments laced with radiation from the U.S. nuclear weapons tests. 

  More than ever, it is clear to us that the U.S. government’s position regarding radiation exposure in the RMI is antiquated, and needs to be updated.  The U.S. position maintains that radiation exposed only the populations of Rongelap and Utrik to levels of radiation sufficient to warrant U.S.-provided healthcare for radiation related illnesses.  Estimated numbers by the NCI for future radiation-related cancers are higher than the current number of patients currently enrolled in the Department of Energy’s medical monitoring and care program and higher than the total populations for Rongelap and Utrik alive during the testing program.  The NCI’s predictions for cancers include likely occurrence for atolls throughout the RMI, not just the northern-most atolls.  The BEIR VII conclusions that low doses of radiation increase risk of harm to human beings, and that there is a substantially greater risk of dying from cancer for women and children, compels us to take further action, and requires our nations to rethink radiation-related healthcare in the RMI.  Remedies are clearly needed, but without U.S. assistance the RMI will continue to lack the capacity to respond to the urgent radiation-related healthcare needs confronting us. 

  Since the U.S. nuclear weapons testing program was conducted at a time when the United States governed the Marshall Islands with the same authorities extended to the United States itself, we believe the same standard of care, safety, redress of grievances and justice that Congress has adopted with respect to U.S. citizens exposed to radiation should be honored for the Marshallese people.  In particular, we think there should be equity in terms of healthcare standards and delivery, environmental clean-up, radiation protection standards for the public, and compensation.  The RMI government hopes to work with this Committee and the House committees that convened a similar hearing in May to develop appropriate authorizing and appropriations language in the upcoming year.  The well-being of our citizens depends on our action.

  Finally, I want to thank this Committee for its continued willingness to address radiological issues in the RMI since the termination of the trust territory, and for the Committee’s creativity in addressing our needs.  The RMI is grateful measures adopted in the past to address healthcare, resettlement, trust funds, and clean-up.  We hope that today’s hearing is the beginning of a process to address -- together -- the fundamental inadequacies of our ability to manage on-going and future radiological burdens in the RMI. 

  
   

• Thomas Lum

  Specialist in Asian Affairs

  Congressional Research Service

  Read statement

  Witness Panel 1

  Thomas Lum

  1
  Thomas Lum
  Specialist in Asian Affairs
  Congressional Research Service
  Testimony before the Senate Committee on Energy and Natural Resources
  Hearing on the Effects of the U.S. Nuclear Testing Program on the Marshall
  Islands
  July 19, 2005
  Mr. Chairman, Members of the Committee, thank you for the opportunity to represent the
  Congressional Research Service (CRS) at today’s hearing. In March of this year, a team of CRS
  analysts from four divisions examined the Marshall Islands’ Changed Circumstances Petition in a
  report for Congress. Today I will summarize some of the main issues and findings discussed in our
  report. This statement and the CRS report are submitted for the record.
  According to various estimates, the United States has spent between $520 million and $550
  million in the Republic of the Marshall Islands (RMI) on nuclear test-related compensation. This
  funding has been used for health care, environmental monitoring, cleanup of contaminated sites, and
  resettlement efforts. Some of these monies remain in trust funds of the nuclear test-affected atolls.
  So far, the largest effort to settle claims was provided by Section 177 of the Compact of Free
  Association and the Agreement for the Implementation of Section 177. The Compact, authorized
  by the Compact of Free Association Act (P.L. 99-239) and enacted in 1986, established the Marshall
  Islands as a “freely associated state” with special economic and security ties to the United States.
  Section 177 authorized $150 million for nuclear test-related compensation. The agreement, as
  stated, constituted “the full settlement of all claims, past, present and future,” including claims by
  inhabitants of Bikini, Enewetak, and other atolls pending in the United States Court of Claims. The
  investment returns on the Fund were expected to generate $270 million between 1986 and 2001
  while the original $150 million would remain as principal. However, in 2005, the Fund is nearly
  depleted, which the RMI attributes to unanticipated costs and lower than expected returns on
  investments.
  Section 177 stipulated that additional compensation may be requested by the RMI if the
  following conditions were met: loss or damages to persons or property arose or were discovered that
  could not reasonably have been identified as of the effective date of the Compact; and such injuries
  rendered the provisions of the Compact “manifestly inadequate.” In September 2000, the Marshall
  Islands government submitted to the United States Congress a Changed Circumstances Petition
  pursuant to the Compact. In 2003, the Compact of Free Association Amendments Act (P.L. 108-
  188) authorized continued Marshall Islands eligibility for many U.S. federal programs and services.
  These included some health, food, and agricultural programs for nuclear test-affected atolls.
  However, negotiations to renew the Compact and to extend economic and other assistance did not
  include consideration of the Changed Circumstances Petition.
  The Petition justifies its claims of “changed circumstances” largely upon “new and additional”
  information since the Compact’s enactment. The RMI refers to more stringent U.S. radiation
  protection standards, issued in 1997 and 1999, and to Department of Energy records, declassified
  in the early 1990s, that indicate a wider extent of radioactive fallout than previously known or
  disclosed. The RMI contends that this new information warrants further cleanup of contaminated
  U.S. Department of State, Report Evaluating the Request of the Government of the Republic of the Marshall 1
  Islands Presented to the Congress of the United States of America, November 2004.
  CRS Report RL32811, Republic of the Marshall Islands Changed Circumstances Petition to Congress. 2
  2
  soil as well as cleanup over a wider area. Furthermore, Marshall Islands representatives assert that
  the Nuclear Claims Fund constituted a provisional, “political settlement” rather than a final
  determination based upon a conclusive, scientific assessment of costs.
  The Petition originally requested a total of $3.3 billion including:
  ! unpaid Nuclear Claims Tribunal (NCT) personal injury awards of $15.7 million
  ! unpaid NCT property damages awards to Enewetak Atoll and Bikini Atoll totaling
  $949 million
  ! $50 million for medical services infrastructure
  ! $45 million annually for 50 years for a health care program for those exposed to
  radiation
  In November 2004, the U.S. Department of State released a report compiled by an interagency
  group evaluating the legal and scientific bases of the Petition. The report concluded that “the 1
  Marshall Islands’ request does not qualify as ‘changed circumstances’ within the meaning of the
  Compact.” The report also disputed some of the main scientific claims of the Petition regarding the
  geographical extent of radioactive fallout, radiation dose estimates, and the applicability of U.S.
  standards to conditions in the RMI.
  The CRS report on the Changed Circumstances Petition analyzes issues related to the Petition’s
  requests. The report examines nuclear test compensation programs in the United States, the health 2
  effects of ionizing radiation in the Marshall Islands, the Petition’s property damages claims, and the
  possibility of further action in U.S. courts. Today, I would like to touch briefly upon them. Another
  question, which has yet to be analyzed in depth, is how to assess and fund nuclear test-related health
  care needs in the Marshall Islands.
  The Compact of Free Association established the Nuclear Claims Tribunal (NCT) to adjudicate
  personal injury and property damages claims. The Compact provided $45.75 million out of the $150
  million Nuclear Claims Fund for payment of personal injury awards. The Tribunal’s system of
  personal injury compensation is based upon the U.S. Radiation Exposure Compensation Act, also
  known as RECA. RECA provides payments to U.S. individuals who lived in a specified area
  “downwind” from the Nevada test site and who have contracted certain cancers that are presumed
  to be the result of their exposure to radioactive fallout. As with RECA, the Nuclear Claims Tribunal
  does not require the claimant to prove a causal link between his or her disease and exposure to
  radiation. The claimant must simply provide proof of residency in the Marshall Islands during the
  years of nuclear testing (1946 to 1958) and have one of the listed compensable diseases. As of June
  2005, the NCT had granted personal injury awards totaling $87.3 million and paid out $71.6 million
  to 1,941 individuals. Some analysts have argued that the eligibility pool, amounts of awards, and
  list of conditions compensated, exceed those provided by RECA.
  In September 2004, the National Cancer Institute (NCI) estimated that nuclear testing raised the
  cancer rate in the Marshall islands by about 9% above the norm or baseline among the population
  exposed to the testing. This would translate to about 530 additional lifetime cancers above the
  baseline of 5,600. The NCI report estimated that about half of the total cancers projected were yet
  U.S. Dept. of Health and Human Services, National Institutes of Health, National Cancer Institute, 3
  Estimation of the Baseline Number of Cancers Among Marshallese and the Number of Cancers Attributable
  to Exposure to Fallout from Nuclear Weapons Testing Conducted in the Marshall Islands, September 2004.
  National Research Council, Assessment of the Scientific Information for the Radiation Screening and 4
  Education Program (Washington, DC: National Academy Press, 2005).
  Steven L. Simon and James C. Graham, “Findings of the Nationwide Radiological Study,” 1994. 5
  3
  to develop or be diagnosed, so additional compensation claims were likely. Based upon this study, 3
  the RMI government projects an additional $100 million in future NCT awards.
  On April 28, 2005, the National Research Council (NRC) released a report on the RECA
  program, in which it recommended against adding any additional diseases to the list of cancers for
  which downwinders and on-site participants may be compensated. The NRC also recommended that
  individual claims be based on probability of causation. This method employs a formula to determine
  whether an individual’s estimated radiation exposure is likely the cause of his or her specific cancer.
  The NRC report may provide alternative models for the Nuclear Claims Tribunal’s system of
  compensation.4
  The CRS report states that the methodology used by the Nuclear Claims Tribunal to estimate
  the value of the lost use of claimants’ properties is viewed as reasonable and appropriate. However,
  the report suggests that the application of the methodology resulted in loss-of-use calculations that
  may be overstated. One possible factor, for example, was the use of average rents per acre that
  largely reflected inflated, government-influenced prices rather than competitive, free-market ones.
  RMI experts counter that real estate appraisals adopted by the Nuclear Claims Tribunal were
  representative of overall market activity in the Marshall Islands and that government rental rates
  were widely accepted in real estate transactions.
  The RMI government argues that the 15 millirem annual dose limit, which it used to estimate
  the degree and extent of cleanup, is the same level of public protection that is provided in the United
  States and that it therefore should be applied to the cleanup of the Marshall Islands. However, as
  explained in the CRS report, the 15 millirem standard is not an enforceable federal regulation.
  Rather, the 15 millirem limit is an EPA recommended guideline that is applied on a case-by-case
  basis, depending on the feasibility of attaining it at a particular site. Consequently, it is uncertain
  whether the 15 millirem standard would be applied if the Marshall Islands were located in the United
  States.
  The CRS report also discusses the debate regarding the extent of contamination. In 1989, the
  RMI government commissioned the Nationwide Radiological Survey, a comprehensive effort to
  determine levels of radioactivity in the soil on islands potentially affected by fallout. The study was
  funded by the U.S. government and completed in 1994. The Survey results suggested that unsafe
  levels of radiation existed primarily in the four northern atolls of Bikini, Enewetak, Rongelap, and,
  to a lesser extent, Rongerik. These atolls would require limited remediation and/or dietary
  restrictions. The RMI disagreed with these findings and claimed that the extent of contamination 5
  and health risks were understated.
  The CRS report identifies four broad policy options in considering whether to provide
  additional financial compensation to the Marshall Islands. These options include:
  4
  ! Grant or reject the Changed Circumstances Petition’s requests, in whole or in part,
  on the basis of changed circumstances;
  ! Provide assistance through ex gratia congressional appropriations measures
  (primarily through the Department of the Interior);
  ! Enact legislation that would provide for a “full and final settlement” of claims;
  ! Through an amendment to the Compact of Free Association, turn jurisdiction over
  the Petition’s claims to the U.S. federal courts.
  My colleagues and I can respond to specific questions related to our report. Thank you.

   

• James Plasman

  Read statement

  Witness Panel 1

  James Plasman

  Statement of James H. Plasman
  Chairman, Nuclear Claims Tribunal
  Republic of the Marshall Islands
  Before the Senate Committee on Energy and Natural Resources
  July 19, 2005

  
  The number of cancers and other health effects resulting from the nuclear testing program in the Marshall Islands greatly exceeds what was known at the time the Section 177 Agreement became effective in 1986.  While there were grounds for an argument of changed circumstances under the terms of the Section 177 Agreement even before the recent study by the National Cancer Institute (“Estimation of the Baseline Number of Cancers Among Marshallese and the Number of Cancers Attributable to Exposure to Fallout from Nuclear Weapons Testing Conducted in the Marshall Islands,” prepared for Senate Committee on Energy and Natural Resources, September 2004,) the results of the NCI study firmly establish the existence of changed circumstances. 

  The baseline of what was known about radiation health effects may be established by a paper, presented in October 1987 to the Japanese Nuclear Medicine Society by Jacob Robbins (Clinical Endocrinology Branch, National Institutes of Health, Bethesda, Maryland) and William H. Adams (Medical Department, Brookhaven National Laboratory, Upton, New York), two well established scientists with significant experience in the Marshall Islands (Brookhaven National Laboratory was the institution charged with observing and reporting on the health of the affected Marshallese people.)  This paper, “Radiation Effects in the Marshall Islands,” was later published in Radiation and the Thyroid: Proceedings of the 27th Annual Meeting of the Japanese Nuclear Medicine Society, Nagasaki, Japan, October 1 -- 3, 1987, Shigenobu Nagataki, editor, Excerpta Medica, Amsterdam-Princeton-Hong Kong-Tokyo-Sydney, 1989. 

  In terms of early radiation effects, they reported on Rongelap “about two-thirds of the people developed anorexia and nausea and one-tenth had vomiting and diarrhea . . . skin burns appeared after 12 - 14 days in about 90% of the Rongelap inhabitants.”

  In regards to late effects, they noted: “It has become evident that thyroid abnormalities - which include benign and malignant thyroid tumors and thyroid failure - are the major late effects of the radiation received by the exposed Marshallese.”  They found the following thyroid effects, through 1986:  2 cases of profound growth failure in two boys due to radiation related thyroid atrophy; 12 cases of hypothyroidism not related to thyroid surgery; 51 observed thyroid nodules (16 expected, 35 excess;) 9 observed thyroid cancers (2 expected, 7 excess.)

  They observed three fatal cancers (leukemia, stomach cancer, and cranial meningioma) and six “nonlethal” tumors (a neurofibroma, a breast cancer, a colon cancer, and three pituitary tumors) as other “late radiation effects -- or possible radiation effects.”

   
  It should also be acknowledged that the U.S. Department of Energy in 1982 (“The Meaning of Radiation for Those Atolls in the Northern Part of the Marshall Islands That Were Surveyed in 1978”) estimated an additional two cancers would result from exposures in the thirty years following the Radiological Survey of the Northern Marshall Islands, conducted in 1978. 

  These findings establish what was known about health effects of the nuclear testing program at the time of the Section 177 Agreement. 

  The NCI study establishes a basis for what we know now about these test related health effects, and reveals the following comparisons of radiation induced cancers:

  Cancer          1986 (Adams/Robbins)   Current (NCI)

  Leukemia      1           5
  Stomach      1        15
  Colon       1      157
  Thyroid      7       262
  Other       6 (includes non-lethal tumors)    93
        16      
  +2 (DOE future cancers) 
  Total     18      532

  If the same ratio of radiation excess thyroid nodules (35) to excess thyroid cancers (7) that appears in the Adams/Robbins paper is applied to the NCI estimate of 262 excess thyroid cancers, the number of radiation caused thyroid nodules would be 5 x 262 = 1310.  These thyroid disorders, attributable to the nuclear testing program, are health effects suffered by the Marshallese people in addition to the cancers estimated by the NCI.

  The stark contrast of what was known at the time of the Section 177 Agreement about the health effects resulting from the testing program and what is known now in light of the NCI study must be regarded as a changed circumstance. 

  While the Petition as originally filed included a request of $26.9 million for the unpaid balance of personal injury awards, that amount now stands at $15.7 million.  However, with more than half the cancers estimated by the NCI yet to develop, that amount reflects only the current balance due and does not reflect future awards. 

  The Tribunal was justified in adopting the presumption of causation approach.

   
  In adopting a presumption of causation approach, the Tribunal primarily relied upon the precedent set by the Radiation-Exposed Veterans Compensation Act of 1988, Public Law 100-321, and by the Radiation Exposure Compensation Act (RECA) of 1990, Public Law 101 426, particularly with its application to the Downwinders - those residents in the areas around the Nevada testing grounds who were affected by fallout from the tests.  A primary source of scientific support for these programs was the work of the National Academy of Sciences' Committee on the Biological Effects of Ionizing Radiation.  Passage of the Veterans Compensation Act in 1988 relied primarily upon the Committee’s third report, so-called BEIR III, while RECA had the benefit of BEIR V.  The BEIR V Committee made heavy reference to the work of the Radiation Effects Research Foundation (RERF), a bilateral undertaking of Japanese and American scientists to study the human health effects of the atomic bombings of Hiroshima and Nagasaki. The Committee also used data from other well studied human populations exposed to radiation and referred to experimental studies on laboratory animals.  Of particular importance, supporting the use of a presumption of causation, was the determination that there was no threshold dose below which stochastic effects such as the development of cancer would not occur.   To the extent that these U.S. programs relied upon this body of work as the scientific basis for compensation, by extension, the Tribunal made similar reliance. 

  In adopting the Veterans Compensation Act and RECA, Congress was clearly motivated by the perception that the government had wronged these victims of radiation exposure and that unreasonable standards of proof should not stand in the way of compensating deserving individuals.  

  Both of these compensatory programs rely upon a presumption of causation to determine eligibility for compensation.  In both situations there was a desire on the part of Congress to enact a system that was fair and reasonable, in light of the difficulties in proof of causation, but also that was efficient and cost effective.  The use of the presumption of causation addressed this desire.  In speaking against an amendment to remove the immunity from law suit of governmental contractors involved in atomic weapons development (floor debate on NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1991, Congressional Record   August 03, 1990, p. S12117,) Senator Grassley of Iowa articulated these concerns: 

  The litigation solution works as a cruel hoax on the intended beneficiaries; it holds out the prospect for recovery, but frustrates the victims by delay and expense. The Justice Department testified that radiation cases take much longer to prepare and try than do most other types of litigation; a typical case would take more than 5 years to resolve. Worse, simply repealing the Warner amendment will do nothing to solve the enormous proof problems that plaintiffs will face, attempting to link their exposure to current disease.

  A straight repeal of the Warner amendment may give some a warm feeling, and it will surely bring a smile to a lawyer's face, but it will mean scant little for those who need help the most.

  Mr. President, these people don't need lawyers, they need money to pay their medical bills, to care for their sick or terminally ill.

   
  If the Government is responsible, and the evidence strongly suggests that it is, then let's create a compensation system outside of the courts to provide relief--faster, without litigation expenses, without having to prove fault, and without lengthy appeals.

  In recent years, we have shown a preference for compensation over litigation, with enactment of the child vaccine compensation legislation, the Radiation -Exposed Veterans Compensation Act of 1988, and the Veterans Dioxin and Radiation Exposure Act (Public Law 98-542) among others.

  The motivation for a simple, reasonable administrative system was strengthened by the perception that the government had not only harmed these victims of radiation exposure, but had done so in a significantly wrongful manner.  In floor comments on the Radiation-Exposed Veterans Compensation Act 1988 (see Congressional Record   Senate for April 25, 1988, pgs. 4637 4641), Senator Cranston of California said, "Science has clearly proven that ionizing radiation can produce serious adverse human health effects.  While we do not have all the answers as to how much radiation exposure is necessary before the various adverse effects appear, there is a long list of cancers for which radiation has been established as a risk factor."  He went on to say that "these veterans were not informed of the risks associated with their participation in the nuclear weapons testing program, nor was their health status systematically monitored thereafter.  Accordingly, I strongly believe that we have the responsibility to ensure that these veterans finally are treated in an evenhanded and compassionate way with respect to their claims for VA benefits."

  The Marshallese people were never informed of the risks associated with their participation in the nuclear tests in the Pacific.  Their health status was never systematically monitored until after the tragic events following the BRAVO test in 1954, and then, only a small fraction of the exposed population was covered.  These similarities between the U.S. affected populations and the Marshallese affected population provide compelling justification for following U.S. precedent in adopting a presumption of causation. 

  The Tribunal provided an in-depth discussion of the reasons for believing the extent of fallout in the Marshall Islands went beyond the four atolls identified in the Section 177 Agreement, on March 18, 2005 in Majuro, to two senior staff members of this committee and to the U.S. Ambassador to the Republic of the Marshall Islands. Attached is a written statement which addresses the points made at that oral presentation. 
   

  In summary of that discussion, the Tribunal felt there was ample information available, even before the NCI study, to support the extension of the presumption of causation throughout the Marshall Islands.  First, is an article which appeared in the Journal of the American Medical Society (Hamilton, T. E.; van Belle, G.; LoGerfo, J. P.; “Thyroid Neoplasia in Marshall Islanders Exposed to Nuclear Fallout,” Journal of the American Medical Association, 258:629 636; 1987), which investigated the appearance of thyroid nodules in 12 atolls previously thought to be unexposed to fallout from the testing program.  The investigators not only found a higher than expected incidence of thyroid nodules in these atolls, but also found the incidence rate showed an inverse linear relationship with distance from Bikini, strongly suggesting that the nodules were caused by radiation from the tests.

  Secondly, the findings of the Marshall Islands Nationwide Radiological Study issued in 1994, reported Cesium 137 levels two to 11 times greater than global fallout at 15 atolls that were not included in the Section 177 Agreement. 

  The release in 1994 of a previously classified Atomic Energy Commission report from 1955 (Breslin, A. J.; Cassidy, M. E.; "Radioactive Debris from Operation Castle, Islands of the Mid Pacific," New York: U.S. Atomic Energy Commission, New York Operations Office, Health and Safety Laboratory; NYO 4623; 1955) provided significant support for the nationwide application of the presumption of causation by the Tribunal.  That report was based on aerial monitoring conducted during the Castle series throughout the Marshall Islands and indicated external radiation exposures to every atoll of the Marshall Islands, in contradiction to the DOE position that only the northern four atolls received fallout from the tests.  Internal exposures would have increased the level of exposure even higher than those reported by Breslin and Cassidy. 

  During the testing program, a monitoring station was maintained on Kwajalein Atoll.  Although the gummed film methodology utilized there provided only a crude measurement of fallout, “The clear indication from the monitoring station was that deposition of fresh fallout occurred at Kwajalein Atoll within a single day following every one of the detonations over 1 megaton explosive yield” (Simon, S. L.; "STATEMENT OF STEVEN L. SIMON, PhD, Director, Nationwide Radiological Study, Republic of the Marshall Islands, Submitted to the United States House of Representatives, Committee on Natural Resources, Subcommittee on Oversight and Investigations in respect to United States Weapons Testing in the Marshall Islands," February 24, 1994.)  These findings were reiterated in a 1997 report (Takahashi, T., et al.; "An Investigation into the Prevalence of Thyroid Disease on Kwajalein Atoll, Marshall Islands," Health Phys. 73:199 213; 1997) that stated the data showed that “all eighteen of the large Marshall Islands tests (those >1 MT explosive yield) were detected at Kwajalein at about 100 X the background radiation level (Simon and Graham 1996).  Presumably, other mid latitude atolls in the Marshall Islands received similar amounts of early fallout as did Kwajalein."

  These studies, and those cited in the attachment, provide an ample basis for the extension of the presumption of causation throughout the Marshall Islands. 

  The Tribunal has not “overcompensated.”
   

  While the Tribunal has made awards to 1,941 individuals, it would be a misstatement to say that all these awards are for past cancers, because in fact more than 1,000 are for non-malignant thyroid conditions.   As noted by Robbins and Adams in their 1987 paper, “It has become evident that thyroid abnormalities -- which include benign and malignant thyroid tumors and thyroid failure -- are the major late effects of the radiation received by the exposed Marshallese.”  Although the full extent of those effects was not recognized at the time of the paper’s presentation, the sensitivity of the thyroid gland to radiation, beyond the development of cancer, has long been recognized. 

  The NCI study addresses only cancers and states, “Estimation of diseases other than cancer is more problematic . . . and would require access to expertise and data not readily available at the National Cancer Institute.” 

  As noted above, based on the Robbins and Adams findings on the relationship between thyroid nodules and thyroid cancer, and based on NCI’s estimate of 262 excess radiation related thyroid cancers, 1,310 radiation related thyroid nodules could be expected to occur in the Marshall Islands.  Another 144 of the Tribunal awards are for radiation sickness and beta burns, both of which are directly related to radiation exposure, but are not cancerous conditions. 

  It should be noted that these non-malignant conditions are awarded compensation at levels significantly less than award levels for cancers.  The most lethal and serious cancers are awarded up to $125,000 by the Tribunal (with downward adjustments based upon the age at which the condition manifests,) while a benign thyroid nodule not requiring surgery is awarded $12,500. 

  It must be understood that while the Tribunal has made more awards for cancer than the NCI estimate of radiation excess cancers, there are no clinically distinguishing features of a radiation related cancer to differentiate such cancers from non-radiation caused cancers.

  This central fact of radiation related cancers lies at the heart of the presumption of causation utilized by the Tribunal and by Department of Justice for Downwinders in the United States under the Radiation Exposure Compensation Act and by the Veterans Administration for its statutory program for radiation exposed veterans.  In order to meet the goals of the programs to compensate the victims of radiation exposure, it is deemed better to compensate broadly than to neglect compensation for those who are unable to prove with scientific certainty that their conditions were in fact caused by their radiation exposures.  Built into such programs is the limitation of awards to set amounts which recognize the over-inclusive nature of the compensatory scheme.  Surely if an individual awardee, whether a Downwinder, or a Marshall Islander, were able to prove to the satisfaction of a court the causal connection of the awardee=s condition to radiation exposure, the measure of damages would be far higher than the awards provided either by RECA or by the Tribunal.

  This aspect of these programs was clearly recognized in comments on the floor of the House during discussion of the Radiation Exposure Compensation Act on June 5, 1990, as Representative James of Florida remarked (p. H3144, Congressional Record):

   
  Mr. Speaker, I would like to point out in this bill; I do not think it has been said yet, or, if it has, it has not been emphasized as much as it might, but the limitations in this bill are only $50,000 for the downwinders. That is hardly tantamount to a large tort claim award, which could be in the millions.

  It also has a savings aspect to it to the Government. It saves the attorneys fees, the expenses and the costs, a portion of which we are awarding would be consumed anyway. So, there is actually a substantial savings, probably to the Government, maybe not to the tune of the total amount of the judgments.

  Similar comments can be made about the miners' $100,000. That is insignificant compared to a judgment that might be awarded if clear liability were found.

  So, this is not like giving the full amount that a jury might give. It is only a fractional part to ease some of the pain economically to these miners.

  If the award levels were based on the value of a statistical life, as utilized by regulatory agencies for cost-benefit analysis, the award levels would likewise be much higher.  For instance, it has been reported (“Valuation of Human Health and Welfare Effects of Criteria Pollutants,” Appendix H, The Benefits and Costs of the Clean Air Act, 1990 to 2010, EPA, 1997) that while values differ from program to program, the mean value of a statistical life for regulatory purposes is $4.8 million.  Even acknowledging that not all cancers in the NCI study are fatal, the level of compensation determined under such a methodology would far exceed what the Marshall Islands received under the Section 177 Agreement for all damages, not simply personal injuries. 

  It has been argued that a probability of causation or “assigned share” approach to compensation would provide a more precise means of targeting compensation to those actually affected by the testing program.  One of the dangers in such approach is that by its nature, it looks only at the probabilities in a case and does not provide an answer to causation in fact.  As a result, a claimant whose cancer was caused in fact by exposure to radiation could fail to qualify for compensation because the probabilities were against him or her.  A further difficulty is the cost of implementing such a system.  One expert estimates the cost of each reconstruction, based on EEOICPA experience could run as high as $30,000 to $40,000. 

  More importantly, there is simply insufficient information to recreate individual doses for people in the Marshall Islands for the purposes of a probability of causation analysis.   As noted in the NCI study:  “Following the nuclear tests that took place some 50 years ago in the Marshall Islands; measurements were sparse and generally uncertain. The little data now available to reconstruct doses at many different locations present difficult challenges for dosimetrists.”  
   
  In the compensation program established for U.S. Department of Energy employees exposed to radiation (EEOICPA), a probability of causation approach is utilized.  Energy employees worked in a closely monitored environment where many wore dosimetry badges which provide a basis for precise dose reconstructions.  Even in these controlled situations, EEOICPA provides for a presumption of causation approach when there is insufficient information to adequately reconstruct doses and where there is a reasonable likelihood of exposure to harm.  The level of data for Energy employees far exceeds that available in the Marshall Islands.  The NCI report shows excess cancers throughout the Marshall Islands, even in the southern-most atolls characterized by NCI as “very low exposure.”  This excess presents a reasonable likelihood of harm to the entire Marshall Islands.  Under these circumstances and the precedent set by EEOICPA, the extension of the presumption of causation throughout the Marshall Islands is reasonable.   

  What is needed.

  While the Petition as originally filed included a request of $26.9 million for the unpaid balance of personal injury awards, that amount now stands at $15.7 million.  However, with more than half the cancers estimated by the NCI yet to develop, that amount reflects only the current balance due and does not reflect future awards.  At the end of 2003, the Tribunal had awarded $83 million.  The NCI reports:  “About 56% of the total radiation-related cases have yet to develop or to be diagnosed, compared to about 50% of the baseline cancers. This temporal distribution reflects the generally young age structure of the exposed population and the greater sensitivity at younger ages to radiation carcinogenesis.” (p. 16)   Assuming the NCI estimate of past and future cancers reflects the same ratio of overall health conditions compensated by the Tribunal past and future, and assuming the Tribunal compensation scheme is fair and reasonable, then the $83 million awarded at the end of 2003 represents 44 percent of the level of fair and reasonable compensation for personal injuries.  Assuming 56% of conditions will need to be compensated after 2003, then another $105.6 million will be necessary for personal injury compensation (56/44 x 83 = 105.6.) 

  The significant number of future cancers and other medical conditions will also require assistance for surveillance and treatment of these conditions.  Finally, appropriate treatment of Tribunal property awards is necessary, through referral to the federal courts.

   

• Mr. Howard Krawitz

  Acting Assistant Secretary

  U.S. State Department

  Read statement

  Witness Panel 1

  Mr. Howard Krawitz

   

   

   

  
   Howard M. Krawitz
  Director of Austalia, New Zealand and Pacific Island Affairs
  U.S. Department of State

   

  Testimony
  before the Committee on Energy and Resources
  United States Senate

   

  Hearing on the “United States Nuclear Legacy in the Marshall Islands:
   Consideration of Issues Relating to the Changed Circumstances Petition”

   

   

   

   

   

  July 19, 2005, 2:30p.m.
  366 Dirksen Senate Office Building

  
   

   Chairman Domenici, Senator Bingaman, distinguished Senators,
  thank you very much for the chance to speak with you today about the important topic of the Government of the Republic of the Marshall Islands’ Changed Circumstances Request and the Administration’s report prepared at the request of the Congress. 

  I will start with a brief historical overview.  The United States carried out sixty-seven underwater, surface and atmospheric nuclear tests on and near the Bikini and Enewetak atolls in the northern Marshall Islands between 1946 and 1958, while they were part of the Trust Territory of the Pacific Islands.  The United States still deeply regrets the 1954 “Bravo” accident that harmed 253 downwind islanders.  We remain concerned about the damage done to the people and environment of the Marshall Islands caused by the nuclear tests in the 1940’s and 1950’s.  

  The U.S. Government established programs for the people of the Marshall Islands to monitor and remediate the effects of those tests beginning in the 1950’s, with additional programs created in the 1960’s, 1970’s and 1980’s.  We remain engaged in addressing these problems.   The United States has spent more than $531 million for health and environmental remediation specifically related to the nuclear testing program since the 1950’s.  That assistance is worth over $837 million in 2003 dollars.  Our colleagues in the Department of Energy continue to provide a superior level of health care service for those people directly affected by the nuclear tests, and have in fact provided health care to other populations as well for many years.   The Administration’s report in January outlines in great detail in an appendix the hundreds of millions of dollars the United States has spent in past and present U.S. remediation efforts.

  In the 1980’s, the United States and the Marshall Islands negotiated the Compact of Free Association, which went into effect on October 21, 1986 (PL 99-239 Stat. 1770).  The Compact included a “full settlement of all claims, past, present and future” resulting from the U.S. nuclear testing program.  This Section 177 Settlement Agreement provided $150 million to the Marshall Islands to establish a Nuclear Claims Fund and an independent Nuclear Claims Tribunal to adjudicate all claims.  

  Article IX of the Section 177 Settlement Agreement, entitled “Changed Circumstances,” is the only provision for the Government of the Republic of the Marshall Islands (RMI) to request the United States Congress to consider additional compensation for injuries resulting from the nuclear tests.  In order to be the subject of such a request to Congress under Article IX, an injury:

  (1) must be loss or damage to property and person of the citizens of the Marshall Islands;
  (2) must result from the Nuclear Testing Program;
  (3) must arise or be discovered after the effective date of the Agreement (October 21, 1986);
  (4) must be injuries that were not and could not reasonably have been identified as of the effective date of the Agreement; and
  (5) such injuries must render the provisions of the Section 177 Settlement Agreement manifestly inadequate.

  In Article IX, the Governments of the Marshall Islands and the United States also noted: “It is understood that this Article does not commit the Congress of the United States to authorize and appropriate funds.” 

   In 2000, citing Article IX of the Section 177 Settlement Agreement, the Government of the Republic of the Marshall Islands submitted to the President of the Senate and the Speaker of the House of Representatives a request that certain claims totaling over $3 billion be considered by the Congress for compensation.   In March 2002, the Senate Energy and Natural Resources Committee and the House Resources Committee formally asked the Administration to evaluate the RMI’s request.  Over the following months, the State Department convened a working group of U.S. Government departments and technical agencies that carefully and methodically reviewed the request and the existing scientific studies of the impact of nuclear testing in the Marshall Islands. 

  On January 4, 2005, the State Department submitted the Administration’s evaluation to Chairman Domenici, Senator Bingaman, Chairman Pombo and Congressman Rahall.  The RMI’s submission to Congress did not meet the criteria of “changed circumstances” as required by Article IX of the Section 177 Settlement Agreement, and there is therefore no legal basis under the Settlement Agreement for considering additional payments.   I am submitting a copy of the complete Administration report as an attachment to this testimony for the record.

  Let me briefly address the major areas in which the RMI argues “changed circumstances.”  First, the RMI asserts that exposure to radioactive fallout significantly affected an area well beyond the northern atolls and islands.  The vast majority of scientific evidence, however, documents that the elevated levels of radiation are limited to the most northerly atolls and islands, and that even many historically inhabited northern islands can be resettled under specific conditions.  At the time of the Section 177 Settlement Agreement, the Marshall Islands acknowledged that, within the northern atolls, some islands would be less habitable than others and some would only have limited use.   The Government of the Marshall Islands took the responsibility to control the use of areas in the Marshall Islands affected by nuclear tests.
   
  Second, the RMI seeks comprehensive primary, secondary and tertiary health care systems to serve all the people of the Marshall Islands  for fifty years.  This argument draws an unsubstantiated link between current public health and medical problems in the Marshall Islands and the U.S. nuclear testing program.  In fact, the United States has provided extensive medical care to the populations living on the atolls where testing occurred.  The Section 177 Settlement Agreement provided $2 million per year for 15 years from the Nuclear Claims Fund to provide medical care to the people of Bikini, Enewetak, Rongelap and Utrik atolls.  The estimated population of the four atolls in 1954 was approximately 500 people.  That program currently serves 13,460 people, fully one-quarter of the national population.  Due to subsequent Congressional action, these communities are receiving similar services through a grant from the Department of the Interior through September 30, 2005. 

  In addition, starting in 1954, Congress mandated a special medical program for the members of the population of Rongelap and Utrik who were exposed to radiation resulting from the 1954 “Bravo” test (253 people).  This program is run by the Department of Energy.    Neither the Section 177 Settlement Agreement nor the larger Compact envisioned the United States providing comprehensive health care for all the people of the Marshall Islands indefinitely, and there is no basis under Article IX to request such a program.

   Regarding three other categories – personal injury, loss of land use and hardship, and atoll rehabilitation – the RMI claims as  “changed circumstances” the fact that the Nuclear Claims Fund has had a mixed earnings record and that the Nuclear Claims Tribunal, set up and run by the Marshall Islands, has chosen to award more funds than generated by the Nuclear Claims Fund.  The Tribunal’s decisions to set award amounts well above the amount of funds available in the Nuclear Claims Fund  do not constitute “changed circumstances” under Article IX of the Section 177 Settlement Agreement. 
   
  The final broad category of RMI claims includes occupational safety, nuclear stewardship and education.  The Governments of the Marshall Islands and the United States decided not to include those types of programs in the Section 177 Settlement Agreement.  The lack of those programs and the desire to have such programs are not “changed circumstances” as defined in the Settlement Agreement. 

  I would like to close by underscoring an important point.  The Administration’s report evaluated the specific question of whether the Government of the Republic of the Marshall Islands’ submission qualified as “changed circumstances” under Article IX of the Section 177 Settlement Agreement.  The Administration’s report does not describe the overall relationship between the United States and the Republic of the Marshall Islands.  Shared history and common values make our friendship with the Marshall Islands one of the strongest in the world.

  The history of the nuclear testing program and the settlement of claims arising from that program are but one facet of the unique and longstanding friendship our two nations enjoy, a relationship of mutual understanding and shared values that remains strong today.  The Compact of Free Association of 1986 and the amendments that went into effect just last year link our two nations together for the foreseeable future and guarantee direct U.S. assistance to the RMI for twenty years.  Under the amended Compact, our two nations have established a trust fund to provide an ongoing source of income for the RMI after Compact assistance ends to be used for the same purposes as current assistance.  The amended Compact highlights health care as one of the two primary focus areas out of six sectors for assistance grants.  For 2005, the Republic of the Marshall Islands and the United States have agreed to spend nearly $16 million on health care using Compact funds, and we project similar amounts for each of the next several years.  Hundreds of millions of dollars in Compact funds flowed to the RMI during the first eighteen years of free association (1986-2004), and over the next twenty years under the amended Compact, the United States is committed to spend over $1.2 billion in direct assistance and trust fund contributions.  The RMI also remains eligible for a number of categorical and competitive public health grant programs administered by the U.S. Department of Health and Human Services in the same way as U.S. states and territories.    

  The Administration recognizes serious and continuing public health and medical challenges in the Marshall Islands and supports the Government’s efforts to meet those challenges.  The Republic of the Marshall Islands is a global partner and a valued friend, and the United States will, through the Compact and other means, remain engaged and committed to building a better future for the people of the Marshall Islands.   We look forward to continuing to work together on a host of issues of mutual concern to both our nations. 

  Thank you very much for this opportunity. 
  

• Dr. Steve Simon

  Read statement

  Witness Panel 1

  Dr. Steve Simon

  Thank you, Mr. Domenici, for your invitation to appear today before the Senate Committee on Energy and Natural Resources. I am Steven L. Simon, PhD. I am employed by the National Cancer Institute, National Institutes of Health (NIH), but I am here today solely in a personal capacity. I am only representing myself. My statement today has not been prepared or influenced by my present employer, nor has it been reviewed at the NIH. Hence, this statement does not necessarily represent the opinion of the NIH. I request that my statement be entered into the record.
   I would first like to present my credentials relevant to this hearing. In addition to a B.S. and M.S. degree in Physics and Radiological Physics, respectively, and a Ph.D. in Radiological Health Sciences, I have approximately 28 years experience in the field of radiation epidemiology, radiation treatment of cancer, and radiation protection. My primary fields of expertise are radiation measurement and radiation dosimetry. I was employed by the Government of the Marshall Islands from early 1990 through mid-1995 as the sole radiation scientist in residence in the RMI. In that position, I directed the Marshall Islands Nationwide Radiological Study from its inception through its completion and designed and oversaw the construction of the first permanently based radiological measurements laboratory in the Marshall Islands. During that time, I was also a member of the 3-person scientific management team for the U.S.-funded Rongelap Resettlement Project and was director of the Nationwide Thyroid Disease Study. Since leaving the RMI, I directed the radiological survey of Johnston Island, another U.S. Pacific nuclear test site. I was a member of the International Atomic Energy Agency (IAEA) survey teams of the French nuclear test sites in Algeria and in French Polynesia. I was the lead dosimetrist in the well known epidemiologic studies of downwinders conducted by the University of Utah and am presently the lead dosimetrist in the NCI’s current study of thyroid disease in areas adjacent to the former Soviet nuclear test site in Kazakhstan. I formerly have had research and academic faculty appointments at the University of New Mexico, University of Utah, and University of North Carolina at Chapel Hill. Presently, I hold adjunct faculty appointments at Colorado State University and Baylor College of Medicine. I am an elected member of the National Council on Radiation Protection and Measurements. I am a member of the editorial board of Health Physics, the most prestigious journal in this country in the field of radiation protection and have been on that editorial board for the last 13 years. I have an extensive publication resume and have authored 18 peer-reviewed papers, 19 reports or book chapters and 1 book, all on issues related to radiation in the Marshall Islands.
  The primary purpose of my testimony is to provide this committee with accurate and unbiased scientific and technical information related to the effects of nuclear testing in the Marshall Islands. My purpose does not include taking a side in the discussion for the need or justification for additional compensation. In my view, that is a political decision that should consider sound scientific data. It is my goal to provide information so that neither incorrect nor incomplete information is used to make such decisions.
  There are three subject areas that I primarily want to convey information to this committee about. These are: (1) The Nationwide Radiological Study that I directed, (2) Nationwide Thyroid Disease Study that I also directed, and (3) to correct various testimonies provided by others at the House hearing in May 2005 that I thought were lacking in accuracy, completeness, or transparency.
  The findings of the Nationwide Radiological Study (NWRS) are relevant to this discussion about the effects of nuclear testing in the Marshall Islands. Though they are not the only data available on levels of contamination, they are the most complete in terms of geographic coverage. Other data and information collected for many years under sponsorship of the Dept. of Energy is also highly valuable and credible. See the website of the Dept. of Energy Marshall Islands Program [1] for a wealth of data and publications. In particular, the Dept. of Energy sponsored a radiological survey of the northern Marshall Islands in 1978 [2] that included an aerial survey [3] as well as ground sampling. The measurements of Cs-137 (cesium-137) in the environment from the DOE sponsored survey agreed well with measurements made by the NWRS many years later [4]. 
  Despite my gratification at seeing the recognition of the NWRS data, I find it disconcerting that more than 10 years after the study was completed, the RMI Government has not publicly acknowledged it or its findings. This curious situation stems back to events in early 1995 following the completion of the NWRS. After the study report was delivered to the NCT, the Nitijela (parliament) of the Marshall Islands invited me to present the findings to them while they were in session, but upon arriving at their chambers on more than one occasion, they never actually allowed me to make the presentation. Near to that time, Mr. Bill Graham of the Nuclear Claims Tribunal provided in-person oral testimony to the Nitijela to discredit the study.  Whether that testimony was a legitimate undertaking for an official of the NCT seems relevant to this discussion, though it is of little personal concern to me at this late date. Following Mr. Graham’s testimony, the Nitijela enacted a resolution to formally reject the findings of the NWRS. Neither the Nuclear Claims Tribunal website nor the RMI Embassy website acknowledges the study or has made its findings available.
  Findings of publicly funded scientific investigations should be published and the information made available. To that end, I went to great effort to publish the findings of the NWRS without any salary or financial support. In 1997, I was one of two appointed editors of a special issue of the journal, Health Physics, completely devoted to the radiological consequences in the Marshall Islands. The issue included 23 papers by 60 authors in addition to me. The Marshall Islands Government, for reasons never apparent to me, tried to stop publication of that issue. This issue has been available in its entirety on the internet [5] since a short time after publication, courtesy of Health Physics and the Department of Energy. In addition, I have made the summary report of the NWRS available for the last 8 years online [6], courtesy of the Baylor College of Medicine that maintains the website.
  The primary goal of the NWRS was to document the geographic distribution of residual radioactivity from the nuclear testing conducted in Bikini and Enewetak and to assess the present and future levels of residual radioactivity. The study was designed to be scientific in nature, objective in its conclusions, and was designed and conducted without any political purposes in mind. The NWRS was extremely successful in documenting the radiological conditions over the entire nation [7,8]. In addition to being published in the scientific peer reviewed literature, the data was reviewed either in its entirety or in parts, by three expert international groups, including the RMI Government appointed Scientific Advisory Panel and the IAEA panel to review the radiological situation of Bikini atoll. There has not been a single scientifically based challenge to its quantitative findings or to its degree of comprehensiveness. Despite that there are over 1,000 islands of varying size in the RMI; there is not a single island larger than a bare sandbar where at least one radiation measurement was not made. Moreover, the largest and most important islands in the 29 atolls were the sites of dozens of radiation measurements. Any claim made, that there might still be unidentified hotspots, is unlikely to be true due to comprehensive sampling based on the relative land area of each atoll and the typical variability of measurements, and use of systematic grid-based sampling plans. I make the claim, that if one could find a location with higher radiation level than was recorded by the NWRS, it would be of inconsequentially small size.
  One of our areas of emphasis was measurement of Cesium-137 (Cs-137) in the terrestrial environment, e.g. soil, fruits, etc. Cs-137 has been measured worldwide as a marker of fallout contamination since it is only produced by nuclear fission. It has a 30-year half-life and modern instruments conveniently detect it. The NWRS documented the average as well as the range of contamination at all atolls of the Marshall Islands, even those islands and atolls traditionally uninhabited. We measured all other detectable gamma emitting radionuclides as well, though, in general, they are of low concentration and of little interest from a dosimetric point of view. In addition, we measured fallout plutonium in soil.
  Cs-137 was detectable at all atolls, but this is hardly surprising since it is detectable virtually anywhere in the world as a consequence of fallout from atmospheric nuclear tests conducted throughout the world.  We compared the measured levels of Cs-137 to the value expected in the mid-Pacific region from the deposition of global fallout to discern the atolls where locally produced fallout was in excess of the background from global fallout. At this point, I would now like to refer to Fig. 1 which presents the measurements of Cs-137 in soil from the NWRS, ordered from left to right by the highest observed value at each atoll. You will note that the vertical scale is logarithmic, meaning that each major horizontal line is 10-fold greater than the horizontal line below it. The light gray horizontal band represents the range of values of Cs-137 (as of 1994) deposited in this region of the Pacific from global fallout and is provided as a basis for comparison.
  The NWRS study found that atolls located south of nine degrees north latitude had nearly the same levels of residual fallout activity and that it was at a level indistinguish-able from that expected from global fallout. In the study’s summary report to the RMI Government, I reported that there were 10 atolls for which the study could not conclusively determine whether they had received fallout from the tests conducted in the Marshall Islands. I later learned from a public statement by the now-deceased NCT Chairman, Oscar de Brum, that the NCT interpreted that to be a failing of the study as a result of inadequate funding. That is not the interpretation that was intended, nor was it a failing of any kind. The intended interpretation was the following: if there is any locally produced fallout contamination at those locations, it is very, very small…so small, in fact, that it is indistinguishable from the global fallout that originated from nuclear testing worldwide. Our inability to detect any excess fallout was a result of the diminutive amount of local fallout deposited there. Here, it should be noted that we did not use crude instruments that lacked sensitivity. Our measurements relied on gamma spectrometry with liquid-nitrogen cooled high-purity germanium detectors. These devices represent, even today, the state-of-the-art gamma radiation detection instrument.
  At locations north of 9o north latitude, we observed a moderately smooth increase in the average and maximum level of Cs-137 measured and reached a maximum value on the northern end of Rongelap Atoll, on Bikini Island, and the north end of Enewetak Atoll. That there was a uniform degree of contamination at latitudes south of 9o N, and that it was about the same magnitude as that from global fallout may not have been a surprise to some knowledgeable scientists, though in all honesty, I did not have preconceived expectations since there were few historical measurements on which to base an a priori opinion.
  The observable increase in residual fallout activity above the global background level, at latitudes between 9o and 10o north  (i.e., at Erikub [uninhabited] and at Wotje) can be considered to be new information, though one could have deduced it from the 1955 AEC report by Breslin and Cassidy [9] that followed the CASTLE series of tests. Atolls located north of Wotje (latitude of 9.5o N) were included in the 1978 Department of Energy (DOE)-sponsored aerial radiological survey. Since the NWRS measurements did not appreciably differ from the DOE measurements (except at the lowest contamination levels where the NWRS had somewhat greater sensitivity [4]), there was not a great deal of new information for the northern atolls obtained, except that the DOE measurements were validated, and much more detail about the contamination at Rongelap was obtained during the course of the Rongelap Resettlement Project. But the fact that residual fallout contamination increased north of Wotho to a maximum at Bikini, northern Enewetak and northern Rongelap, had been documented in the DOE survey of 1978.
  Before moving on, I would like to comment on the relationship of the NWRS data to estimating past radiation doses, as well as the value of dose estimation to the changed circumstance petition. In my view, the data obtained in the NWRS, supplemented with other information, can be used for estimating past radiation doses with the understanding that individual estimation is highly uncertain.  It is also my view, however, that estimates of radiation dose, new or old, while not totally irrelevant, are not terribly pertinent to the discussion of changed circumstances. My reasoning is two-fold. First, the compensation plan, as developed by the NCT, has no criterion for admissibility based on radiation dose. That makes dose, largely irrelevant from their standpoint. Second, the radiation-related cancer burden for the nation as a whole is likely to be relatively small compared to that from naturally occurring cancers. Hence, a well-budgeted compensation plan of the sort implemented by the NCT primarily needs to plan to pay for naturally occurring cancers. The number of radiation related cases, which can only be predicted from estimates of radiation dose, adds only a modest increment to the naturally occurring cases [10].
  Now let me briefly address what the measurements of the NWRS imply in terms of future radiation protection requirements. First, it should be realized that measurement of any amount of fallout radioactivity should not be cause for alarm; everyone in the world lives with it today. As a comparison, here in Washington, DC, the amount of Cs-137 per unit area of ground that is attributed to global nuclear testing, is about five-times that in the Marshall Islands [11].
  The data of the NWRS was translated into terms of annual whole-body external effective dose and into annual external plus internal dose assuming that Marshallese eat a diet of 75% locally grown food, a scenario that is unlikely today for most Marshallese. The external dose is received from gamma rays emitted from fallout that is still in the soil, while the total dose calculation includes the dose from Cs-137 that would be ingested from fruits that can absorb Cs-137 from the soil via plant roots.
  According to the calculations of the NWRS in 1994, the external annual effective dose might exceed 100 mrem per year at only a few locations: on northern Enewetak Atoll, northern Rongelap Atoll, and on some islands of Bikini Atoll. The value of 100 mrem per year is accepted internationally as guidance for limiting exposure to the public. It is about equal, for example, to the amount of radiation we receive in the U.S. from natural terrestrial and cosmic ray radiation. Those findings are not different than predicted from the 1978 DOE-sponsored aerial survey of the Marshall Islands.
  Including the dose contribution from ingestion of Cs-137 in locally grown foods might lead to a total annual effective doses in 1994 (though would be 22% to 50% lower today due to radiological decay and ecological elimination) in excess of 100 mrem per year on Rongerik, Enjebi Island of Enewetak, northern Rongelap, and Bikini Island. These findings do not differ from findings available from the 1978 DOE survey except possibly in assuming a diet so highly reliant on local food. These various findings are the basis of the statements by the NWRS and its Scientific Advisory Panel that:
  “…the current levels of radioactive contamination of the territory of the Marshall Islands pose no risk of adverse health effects to the present generation. Similarly, on the basis of current genetic knowledge, we judge the risk of hereditary diseases to future generations of Marshallese to be no greater than the background risk of such diseases characteristic of any population.
  Four atolls have been identified where exposure rates are elevated to the extent that remedial actions are indicated for some of the islands…” [7].
  Now, I would like to briefly turn to the Nationwide Thyroid Disease Study (NWTDS) that I directed in collaboration with medical specialists from England and Japan. Part of the motivation for that study stems from the well-known sensitivity of the thyroid gland of young children to ionizing radiation. Studies elsewhere indicate that exposure to radioactive iodine released from nuclear tests might be responsible for an increase in thyroid cancer. In addition to aiming to provide a public health service by providing free examinations, we set out to examine the hypothesis put forth by Hamilton et al. [12] concerning the prevalence of thyroid nodules among 2273 inhabitants of 14 of the 24 inhabited atolls born before the 1954 BRAVO test. His finding was that the prevalence of nodules decreased among that group with increasing distance from Bikini. His interpretation was that exposure to radioiodines was likely much broader than believed prior to his publication of 1987. The NWTDS examined 4762 Marshallese born before the end of nuclear testing in the Marshall Islands. Our examinations used palpation (feeling of the neck), as did Hamilton, though we also used high-resolution ultrasound that Hamilton did not. We found a relatively high frequency of thyroid cancer and benign thyroid nodules and we provided written medical evidence of each finding to each person examined, the Majuro Hospital, and the Nuclear Claims Tribunal. The high frequency of nodules and thyroid cancer is consistent with observations by other investigators for island locations throughout the Pacific where there is no evidence of exposure to radioactive iodine. Of more relevance here, is that the observations of the NWTDS did not confirm the hypothesis of Hamilton et al., i.e., we did not find a significant decrease in nodule prevalence with increasing distance [13, 14]. Though our data suggested that the occurrence of thyroid cancer might be related to our preliminary estimates of radiation dose, there was no such evidence when the observations from Utrik atoll were removed from the data set. I would like to note here that because our study did not confirm Hamilton’s hypothesis, it does not disprove it. However, replication of scientific findings is considered part of the gold standard in scientific research and our study that was larger and used more sensitive techniques to detect nodules, did not replicate his findings.
  Following the main body of my statement, I provide an Appendix that addresses seven specific areas in which others provided testimony at the House oversight hearing on March 19, 2005. As I explain in the Appendix, some testimony provided to the House committee appeared to me to be either incorrect and/or incomplete and hence, provided a biased view. The purpose of the Appendix is to provide additional information that should also have been provided by those testifying but was not.
  This concludes my statement. I hope you find this information to be useful.
   
   
  Fig. 1.  Maximum observed value of Cs-137 at each atoll from the NWRS in 1994 [7,8].

   
  REFERENCES

  1. http://www.eh.doe.gov/health/marshall/env_docs.html
  2. Robison W.L., Noshkin V.E., Conrado C.L., Eagle R.J., Brunk J.L., Jokela T.A., Mount M.E., Phillips W.A., Stoker A.C., Stuart M.L., Wong K.M. The northern Marshall Islands radiological survey: data and dose assessments. Health Physics 73(1):37-48, 1997.
  3. Tipton W.J., Meibaum R.A. An aerial radiological photographic survey of eleven atolls and two islands of the northern Marshall Islands. Las Vegas, NV: EG&G, EG&G-1183-1758, 1981.
  4. Simon, S.L, Graham J.C. A comparison of aerial and ground level spectrometry measurements of 137Cs in the Marshall Islands. Environmental Monitoring and Assessment - An International Journal 53(2): 363-377, 1998.
  5. http://www.eh.doe.gov/health/marshall/marsh/journal/
  6. http://radefx.bcm.tmc.edu/marshall_islands/
  7. Simon SL, Graham JC. Findings of the Nationwide Radiological Study: Summary Report, submitted to the Cabinet of the Government of the Republic of the Marshall Islands. December 1994. Ministry of Foreign Affairs, Government of the Republic of the Marshall Islands, Majuro, Marshall Islands, 96960. 1994.
  8. Simon SL, Graham, JC. Findings of the First Comprehensive Radiological Monitoring Program of the Republic of the Marshall Islands. Health Physics 73(1):66-85, 1997.
  9. Breslin, AJ, Cassidy, ME. Radioactive debris from Operation Castle, islands of the mid-Pacific. New York: New York Operations Office, Health and Safety Laboratory, U.S. Atomic Energy Commission. NYO-4623 (Del.), 1955.
  10. Estimation of the Baseline Number of Cancers Among Marshallese and the Number of Cancers Attributable to Exposure to Fallout from Nuclear Weapons Testing Conducted in the Marshall Islands. National Cancer Institute report to the Senate Committee on Energy and Natural Resources, September 2004.
  11. Beck HL, Bennett, BG. Historical overview of atmospheric nuclear testing and estimates of fallout in the continental United States. Health Physics. Health Physics 82(5):591-60885, 2002.
  12. Hamilton TE, van Belle G, LoGerfo JP. Thyroid neoplasia in Marshall Islanders exposed to nuclear fallout. JAMA 258:629-636, 1987.
  13. Takahashi T, Trott, K, Fujimori K, Nakashima N, Ohtomo H, Schoemaker MJ, Simon, SL. Thyroid Disease In The Marshall Islands, Findings from 10 Years of Study. Tohoku University Press, Sendai, Japan. 2001.
  14. Gilbert E.S., Land C.E., Simon S.L. Health Effects from Fallout. Health Phys 82(5): 727-735, 2002.
  .
  APPENDIX

  I observed that some information provided in testimonies at the House of Representatives oversight hearing on the Marshall Islands Changed Circumstances petition (May 19, 2005) was either incorrect or did not disclose important but related information in a transparent fashion. Moreover, some individuals implied that new information, of any kind, implied a “changed circumstance.” While in a limited sense, that may be true, many of the points made do not have implications for additional costs to the Marshall Islands now, nor would they have had the information had been available at the time of the earlier settlement. Such testimony, in my view, is disingenuous. The purpose of this appendix is to provide what I believe to be more correct and/or complete information on seven specific points.

  Steven L. Simon, PhD
  July, 2005

   

  (1) Topic: Data on Nuclear Test Yields
  Statement made: Representatives of the Marshall Islands claimed that the data on explosive yields of the nuclear tests conducted in the Marshall Islands that were declassified and released in 1993, constitutes new information that validates the “changed circumstances” petition.
  Relevant facts not disclosed in testimony: The statement that the explosive yields of the tests conducted in the Marshall Islands were declassified in 1993 is accurate, but it should be noted that no part of the present compensation scheme presently is dependent on having access to that information. Furthermore, there is no obvious way in which data on the explosive yields might have been used to design the compensation program. To my knowledge, no program anywhere in the world has relied on such information. Finally, it is should be noted, but was not revealed in the testimony, that, even to this day, the fission yields of the nuclear tests are still classified, and it is the fission yield that determines the amounts of I-131, Cs-137 and all other radionuclides of concern that are produced.

  (2) Topic: Classification of the 1955 Breslin and Cassidy Report
  Statement made: Representatives of the Marshall Islands have claimed that an important Atomic Energy Commission report authored by Breslin and Cassidy (1955)  and potentially important to the original agreement was not declassified until 1995.
  Correction: Readily available information shows that, in fact, the report in question was publicly available since the time of its publication, even though some copies show evidence of having been classified. This fact was brought to light at the 1994 hearing of the Senate Energy Committee under the chairmanship of Senator Bennett Johnston. At that hearing, Merril Eisenbud, former director of the laboratory that issued the report (AEC Health and Safety Laboratory or HASL), testified that the report had always been publicly available. Then in 1997, Eisenbud, published  a statement in Health Physics, a peer reviewed scientific journal, confirming that a non-classified version of the Breslin and Cassidy report had always existed since its publication in 1955 (p. 24 of Eisenbud 1997); see below.
   
  Today, copies of both the previously unclassified and declassified versions of the Breslin and Cassidy report (they are seemingly identical) can be obtained on-line from the Dept. of Energy website (http://worf.eh.doe.gov/) at the URLs given below. Verification of the origin of these versions can be obtained from Ms. Martha DeMarre, director of the Dept. of Energy sponsored archival repository: the Coordination and Information Center (http://www.nv.doe.gov/about/cic.htm).

  Previously unclassified version of Breslin and Cassidy (1955):
  http://worf.eh.doe.gov/data/ihp1d/58769e.pdf
   
  Previously classified version of Breslin and Cassidy (1955):
  http://worf.eh.doe.gov/data/ihp1c/0411_a.pdf

   
  (3) Topic: Publication by Hamilton et al. (1987)
  Statement made: It was claimed by representatives of the Nuclear Claims Tribunal (NCT) that the findings in the publication of Hamilton et al. (1987)  support the “changed circumstances” petition due to statements in that paper such as: “These findings suggest that the geographic extent of radioiodine exposure from the 1954 BRAVO test was much broader than previously assumed.”
  Relevant facts not disclosed in testimony: The Hamilton publication, indeed implies that exposure (without qualification as to the degree of exposure) was more widespread than only at Rongelap and Utrik. In fact, the abstract of the publication states:
  “We conclude that an excess of thyroid nodules was not limited to the two northern atolls, but extended throughout the northern [my emphasis added] atolls…”
  The authors were seemingly not confident in concluding the exposure was significant outside the northern Marshall Islands. With respect to the importance of the BRAVO test, the authors also concluded:
  “Thus, while it is possible that atolls close to Bikini, such as Rongelap, may have been exposed on multiple occasions, it is unlikely that such exposures occurred on distant atolls.”
  More importantly, the testimonies provided at the hearing intentionally did not cite the findings of the more recent and more comprehensive Nationwide Thyroid Disease Study  (NWTDS), a study conducted in cooperation with the RMI Ministry of Health and the Nuclear Claims Tribunal, and funded in part by a grant from the U.S. Centers of Disease Control and Prevention, but to a larger degree from grants from the Japanese Government. As noted in the main body of my statement, the observations of the NWTDS did not confirm the hypothesis of Hamilton et al., i.e., no significant decrease in nodule prevalence with increasing distance was observed4, . The fact that no mention of this study was made seems disingenuous to me.

  (4) Topic: Genetic Risk Among Marshallese
  Statement made: In response to a question from Representative Dianne Watson, a consultant from SC&A Corp. and consultant to the Nuclear Claims Tribunal, stated that current residents of the Marshall Islands, with specific reference to residents of Utrik Atoll, would be subject to genetic risk from present levels of exposure.
  Relevant facts not disclosed in testimony: The effects at low doses of radiation continue to be intensely debated within the scientific community, though it is near universally agreed that genetic risk from radiation exposure is very small. The 2005 report of the National Academies of Science/National Research Council (BEIR VII report, see http://books.nap.edu/catalog/11340.html) verifies that statement, though the report does acknowledges that genetic risk, at least in theory, probably exists. The BEIR VII report states, as did Dr. Mauro, that evidence of genetic radiation risk has never been observed in humans, even among Japanese a-bomb survivors. In that case, what does it mean to say that Marshallese would be subject to genetic risk? Since risk is simply the “likelihood” or “probability” of a detrimental health effect, it is misleading to say Marshallese would be subject to genetic risk without revealing that it is unlikely, based on all accumulated evidence, that any actual genetic effects would be observed among the Marshallese. In fact, the BEIR VII committee stated:
  “More than four decades have elapsed since the genetic studies in Japan were initiated. In 1990, the final results of those studies were published. They show (as the earlier reports published from time to time over the intervening years showed) that there are no statistically significant adverse effects detectable in the children of the exposed survivors, indicating that at the relatively low doses sustained by the survivors (of the order of about 400 mSv or less), the genetic risks, as measured by the indicators mentioned earlier, are very small.”
  Are those data relevant to the Marshall Islands exposures? First, let’s look at the acute exposures received during the testing program. The NCI report of September 2004 to the Senate Energy Committee (Table 1) indicates that the acute red bone marrow dose to the Marshallese, averaged over the 1954 population, was about 45 mGy, about one-tenth the average dose of 400 mSv experienced by the a-bomb survivors. The NCI report also states (p.12), that the dose to red bone marrow was representative of the dose to organs other than thyroid, stomach, and colon. Since the gonads are the organs that, if exposed, could induce genetic risk, and the countrywide average dose to organs was about one-tenth that for the a-bomb survivors, the likelihood of observing the outcome of genetic risk among Marshallese is miniscule. This conclusion logically follows the findings from BEIR VII:
  “Studies of 30,000 children of exposed A-bomb survivors show a lack of significant adverse genetic effects.”
  Using the BEIR VII risk coefficient for radiation-related genetic disease of 0.4% per sievert (Sv), one might predict 3 cases of radiation-related genetic disease among all Marshallese alive during the nuclear testing program, though the number is too few to be observed or to affect the public health in any substantial way. Those 3 cases can be compared to the burden of natural genetic disease that will affect about 10,000 persons out of the 14,000 alive during the mid-1950s.
  The actual question put to the consultant from SC&A by Congresswoman Watson was in reference to residents of Utrik atoll today. The exposures received on Utrik in 1994 were about 0.2 mSv (effective dose) assuming a 75% reliance on local food (p. 74, Simon and Graham, 1997) or less if imported food has a more important role in the diet. The doses are less today and will continue to decrease due to natural radioactive decay. Assuming a population today of about 500 persons and using the BEIR VII risk coefficient for genetic disease of 0.4% per sievert (Sv), the number of predicted genetic effects among that population living their entire life on Utrik would be much, much less than one case. Hence, while in theory, there would be genetic risk imparted to the population of Utrik from residual contamination today, it is much less than the risk from natural genetic disease, much less than the risk from natural background radiation on Utrik, and would not produce, in all likelihood, a single observable case over the entire lifetime of the population. Thus, while in theory, there is genetic risk associated with living on Utrik, it is disingenuous to imply that genetic risk might affect the population negatively or has any significance whatsoever.

  (5) Topic: Estimated Doses from Nuclear Testing
  Statement made: It was claimed by consultants to the Nuclear Claims Tribunal that historical dose estimations, primarily carried out by laboratories of the Dept. of Energy, intentionally or erroneously failed to estimate realistic values and that such failure supports a “changed circumstance.”
  Relevant facts not disclosed in testimony: Such a claim should be moderated with other statements that take note that all historical dose assessments are highly uncertain and that there is no proof or evidence from peer review that dose estimates made by SC&A (the contractor to the NCT) are, in fact, more valid than any others. While I also believe that past estimates may indeed have underestimated the acute exposures received on Rongelap and Utrik, my informal reviews of recent SC&A documents have indicated to me a tendency on their part to overestimate many parameters in the dose assessment, leading to final estimates of dose that are exaggerated. Note that here I do not make a specific claim about the validity of the SC&A estimates, but only to point out that critical peer review is necessary before any dose estimates can be accepted as reliable.
  Dose estimation, as it relates to the NCT program of personal injury compensation, is at the heart of this discussion. Three points appear highly relevant.
  (1) Presently, estimated dose has no bearing on the number of cases compensated by the NCT or the dollar amount awarded per case. In fact, estimated dose has no bearing in any way on the compensation scheme.
  (2) No single set of estimated dose, including historical values, those of SC&A, the NCI, etc., have yet been critically reviewed by experts and determined to be the best and most reliable estimates possible. Hence, without further substantiation, criticism of past dose estimates cannot yet play a role in determining the validity of the RMI changed circumstances petition.
  (3) Finally, and most importantly, no changes in the magnitude of doses estimated years earlier by DOE or recently by SC&A or by the NCI would appreciably affect the budgetary requirements of the NCT. It is useful to note here that the NCI dose estimates are appreciably larger than historical estimates and are believed by the NCI, to tend towards overestimation, having been purposely calculated that way for the purpose of not underestimating the health consequences. Even at the high dose levels recently estimated, the projected cancer excess due to the acute exposures received from the testing program resulted in about a 9% increase in the overall predicted cancer rate. If one accepts the thesis that Rongelap, Ailinginae, and to a lesser degree Utrik, were highly exposed and many of the cancers there were a result of nuclear testing, it is possible remove the projected number of cancers at those three atolls from the total number projected for the RMI to observe the effect in the remainder of the nation where exposures were lower. The NCI estimated that the cancer rate in the rest of the Marshall Islands (where more than 98% of the population resided) was increased by about 5%. Any further changes in dose estimates would only modify the 5% projected increase by very small amounts.

  (6) Topic: Comparison of the NCT Compensation Program to Programs in the U.S.
  Statement made: It was claimed by the Nuclear Claims Tribunal (NCT) that the compensation program enacted by the NCT  “…is a reasonable one, firmly based on the U.S. experience in addressing radiation related injury.”
  Relevant facts not adequately discussed in testimony: The presentation by Judge Plasman of the NCT briefly mentions the magnitude of monetary awards in the Marshall Islands but fails to reveal or justify the magnitude of those awards. While much attention has been give to the like design of RMI compensation plans to U.S. plans, there is no explanation on why award rates are higher in the RMI than in the U.S., for many cancer sites, by 2.5 times in some cases (for example, leukemia: $125,000 in the RMI, $50,000 under RECA in the U.S.). The only argument provided was circular in logic: It could be argued that both U.S. and the Tribunal programs significantly under compensate awardees.” Moreover, why monetary awards would be higher in the RMI, where annual salaries and living expenses are a small fraction of those in the U.S., is vitally unclear.
  The rationale for compensating non-cancer and non-life threatening medical conditions, e.g., benign thyroid nodules, is also unclear and has no precedence in U.S. compensation programs. About one-half of the roughly 2,000 awards made by the NCT have been for benign thyroid conditions. Such conditions are universal and have yet to be proven to be related to the nuclear testing program (see the discussion in Point 3 of this appendix). It appears that the financial difficulties of the NCT can be traced, in part, to the how the NCT has deviated from U.S. models for radiation compensation (i.e., awards for benign conditions and higher award rates for cancers).
  In addition, it was argued, “Our understanding of the extent of and effects of the radiation from the testing program continues to develop in ways that were not known and could not have been known at the effective date of the Agreement.” The specific effects alluded to in that statement are unclear, in particular, which “effects” have impacted the budgetary requirements of the NCT or are responsible for its present fiscal condition. The NCT purposely decided to compensate cancers without regard to the location of exposure or the degree of exposure received. That decision obligated the NCT to develop a program to pay 40% of the population alive at the time of nuclear testing for naturally occurring cancers (about 5,600), as well as the radiation excess cases. It appears, however, that inadequate fiscal planning has not allowed the NCT to complete that obligation even for the naturally occurring cases. Hence, the radiation-related excess cancers cannot be to blame, as that burden is less than a 9% increment to the total cases projected.

  (7) Implications of Clean-up Standards
  Statement made: It was claimed by representatives of the Republic of the Marshall Islands and consultants to the Nuclear Claims Tribunal that present day cleanup standards accepted in the U.S. have not been met in the Marshall Island and hence, warrant a “changed circumstance.”
  Relevant discussion not included in testimony: The claims about present day cleanup standards fail to discuss or disclose the complex issues relating to costs versus benefit and that those issues are intimately related to the discussion. The remainder of this short discussion is simply to bring certain points to light that were omitted from testimony at the House hearing, not necessarily to resolve them. The representative of SC&A, the consulting firm to the NCT, testified:
   “The results of these recommendations [“these” referring either to U.S. EPA standards or those recommended by SC&A – the text of Dr. Mauro was not clear on that point] represent a changed circumstance because the cleanup criteria and cleanup costs determined by SC&A and ruled upon by the Tribunal were not adequately understood at the time of the Section 177 Settlement Agreement.”
  If we assume for argument that clean-up standards today are different than in 1986 at the time the Compact of Free Association was accepted, is there necessarily a requirement to meet standards that were not yet in effect at the time of the agreement? That issue, while fundamental to the discussion, has received little discussion. Moreover, no discussion addressed to what degree the public health might be improved with lower cleanup standards.
  The cleanup standards that are currently supported by the U.S. EPA are those derived from the Comprehensive Environmental Response, Compensation and Liability Act of 1980, commonly called CERCLA or “Superfund”. Other U.S. agencies rely on other standards as discussed in the well-documented CRS report.  CERCLA is likely the most restrictive program, however. It calls for elimination of contamination such that the resulting dose results in a cancer risk of less than 1 in 10,000.
  Before application of such standards, several points should be examined:
  • What locations are in violation of CERCLA standards without exaggeration of the exposure conditions?
  • Is it possible to remediate those conditions without destruction of the living environment? In other words, is non-destructive environmental remediation possible?
  • What are the legitimate costs associated with those remediation activities?
  • Do those costs offer a true cost-benefit in terms of maintaining the public health? Would there be any tangible benefit for the enormous costs involved?

  It is important to note here that there is no precedent under CERCLA for compensating the parties exposed by the offending contamination. The objective of CERCLA is to provide for cleanup of those sites to meet the applicable guidelines. The testimony at the House hearing appeared to make the case that compensation in the amount required to conduct the cleanup is being sought by the RMI. In my view, the RMI should make clear if it is has the sincere intention of undertaking cleanup activities, or whether the money is being asked solely for compensation. If the latter is the case, then cleanup standards accepted in the U.S. are not relevant.
  In addition, it is useful to examine the cost and benefits of remediation (cleanup) strategies. Remediation strategies are viewed as strategies to reduce exposure and the consequential risk for the purpose of maintaining public health. When a dose assessment indicates, for example, that the lifetime risk is 1 in 1,000, but only very small population might be exposed, the costs to remediate that risk become exaggerated compared to the benefits. For example, a dose limit of 100 mrem is equivalent to a lifetime risk of 2 in 1,000 or 0.2%.  However, the lifetime risk of naturally occurring cancer is over 40%, meaning that about 400 cases would develop among 1,000 people for natural or unknown reasons. This comparison shows the high level of protection afforded by today’s radiation protection standards. Similarly, a 25 mrem standard as developed by the U.S. Nuclear Regulatory Commission, or the 15 mrem standard as developed by the U.S. EPA, would result in lifetime cancer risks of 5 in 10,000 or 3 in 10,000, respectively.
  Here, the RMI and U.S. Government should ask: How many people will likely inhabit the atolls in question and what benefits to the public health will be obtained by remediation? Furthermore, are the costs justified for the benefits obtained? A specific example is provided here to attempt to add clarity. Suppose 1,000 people return to one of the atolls that has land that gives an annual dose of 100 mrem per year. If we examine the next 100 years, what is the total cancer risk to persons who might live there? Such calculations require some assumptions, so here I assume for simplicity that the population size is stable and remains at 1,000 (i.e., the birth and death rate are equal). The dose today is delivered almost entirely by Cs-137 (about 90%) and the remainder from Sr-90 (strontium-90), but both have similar half-lives, about 30 years. Hence, we can safely assume that the dose rate decreases with a half-life of about 30 years. The number of persons that will be alive any time during that 100-year period will be about 2,300.
  • The naturally occurring cancers over 100 years will number about 880 and the deaths from those natural cancers will number about 470.
  • The total cancer incidence over 100 years due to the initial dose rate of 100 mrem per year (but decreasing with a half-life of 30 years) will be about 4 cases and the number of excess deaths about 2.
  • If the half-life of Cs-137 in the environment is shorter, about 11 years, as suggested by Robison et al. , the dose rate will decrease faster and the excess number of cancers over 100 years will be less than 2 cases and the excess cancer deaths will be less than 1.
  • Implementing cleanup (remediation strategies) to reduce the initial dose rate to 15 mrem per year will not affect the number of naturally occurring cancer cases equal to 880 (or 470 deaths), but will decrease the radiation-related excess cases to 0.6 (with 0.3 deaths) or 0.25 cases (with 0.125 deaths) assuming a 30-year or 11-year effective half-life of Cs-137, respectively.
  Both the RMI and U.S. Governments should ask, at what monetary cost as well as environmental cost, would reductions from 100 mrem per year to 15 mrem per year be warranted?
  Other points are also relevant. In particular, it should be understood that Marshallese are exposed, similar to persons elsewhere in the world, to natural background radiation of about 240 mrem per year (not counting the additional increment received during international air travel). Some scientists have mistakenly argued that background radiation in the Marshall Islands is much lower than elsewhere, but that argument has been shown to be untrue in most circumstances. The natural background radiation in the Marshall Islands, unlike on the continents where terrestrial radiation accounts for about 80% of the effective dose; in the Marshall Islands, about 80% of the effective dose is due to natural Pb-210 (lead-210) and Po-210 (polonium-210) in seafood.  Thus, natural background radiation is several times higher than even the most permissive cleanup standards.
  Finally, it is necessary to discuss which locations, if any, might warrant remediation. According to predicted effective dose-rates by Simon and Graham (1997)  that assume a 75% locally grown foods (equivalent to a reasonably maximally exposed person), only islands in Rongelap, Enewetak, Bikini, and Rongerik might exceed 100 mrem per year (in 1994), though that is based on the upper confidence level on the estimated doses. Using the median dose from a distribution of values (but still assuming a 75% locally grown diet) exceeded the limit only for Enjebi (Enewetak), Bikini Island, and northern Rongelap (a locattion not used as a permanent residence site). Furthermore, the doses estimated in 1994 are now already likely to have decreased by 50%. A peer-reviewed publication7 indicates the inventory of Cs-137 (cesium-137) is decreasing in the coral atolls of the Marshall Islands faster than by radiological decay alone. The half-life of Cs-137 is 30 years, while the effective half-life, due to natural losses through the soil as a consequence of downward water movement, is estimated to be about 11 years. This means that annual dose rates, estimated in 1994, are already about 50% lower.
  Before the application of cleanup standards is seriously considered, critical review is necessary to determine which islands are legitimately in violation of the exposure standard that is deemed relevant. To accomplish that, only reasonably maximal lifestyles (without excessive exaggeration) need to be considered, and possibilities for remediation that are not destructive to the environment should be sought. For example, while soil removal is very effective at removing contamination, it is very costly, creates disposal problems, and is extremely destructive to the environment. In contrast, application of natural potassium fertilizer is highly effective at reducing dose, actually improves plant growth, and has no negative side effects. This strategy is inexpensive and results in a potential decrease of internal dose to less than 10% of the dose prior to soil treatment.  It works by reducing the uptake of radioactive Cs-137 into locally grown foods. Maintaining the physical environment in the Marshall Islands has a great importance because of the limited land area. Hence, soil removal is a last resort choice and may not be necessary at all, depending on the actual use planned for land. Theoretical use of land should not qualify for compensation since theoretical remediation has no public health benefit. Any awards made should be to compensate for the true costs that are incurred when land is remediated, rather than for theoretical costs of remediation programs that are not intended to be implemented.