Hearings and Business Meetings

SD-366 Energy Committee Hearing Room 02:30 PM

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.