Removing the thyroids

On their trips to America, Marshallese patients suffering from radiation-related nodules on their thyroids were treated at times to sightseeing boat rides around Manhattan. Others were invited to swim at the East Setauket home of Dr. Robert Conard, the head of Brookhaven National Laboratory's medical team in the Marshall Islands.

Many of these patients were then sent on to Cleveland, to be further evaluated by Dr. Brown Dobyns, a thyroid expert at Case Western University's medical school.

During his career, Dobyns joined the Brookhaven team on 13 trips to Rongelap and other islands and performed about 80 thyroid surgeries on the Marshallese. To the Marshallese who experienced these surgeries, BNL's thyroid surgery program was motivated more by research needs than by concern for patients' well-being.

In a 2006 interview, Dobyns, who is now retired, said his aggressive surgical approach was justified to avoid possible cancer of the thyroid. "I had to go through a great deal of abuse from some others because I was doing it more thoroughly," he said.

The thyroid, which plays a role in regulating the body's metabolism, is particularly susceptible to radiation damage.

Newsday's review of records pertaining to BNL's long history in the Marshall Islands shows that the lab oversaw payments of nearly $3 million for thyroid surgeries performed on as many as 117 Marshallese during a three-decade period. At first, in the late 1960s, the surgical patients came from Rongelap, but soon the patient pool extended to surrounding islands like Utirik, where Brookhaven doctors once believed many people had been not exposed to the radioactive fallout from U.S. atomic testing in the 1950s. Documents show about 25 percent of the thyroid surgeries were performed on those once classified as "unexposed."

Congressional legislation in 1977 provided the money, which was funded through the U.S. Department of Interior, records show, and overseen by BNL. In interviews with Newsday, Dobyns and former Brookhaven officials said the payments were necessary.

"There was an incentive to them because these people had essentially no money and no medical care," Dobyns said. "You'd arrive in an atoll and they'd come running and throw their arms around you. But they were anxious because they knew they'd get $25,000 if we operated on them."

While BNL contended surgery actually reduced the number of eventual thyroid cancers, the physician later hired by the United States to oversee the Marshallese medical care questioned whether the operations should have been done in the first place.

"A total thyroidectomy was definitely overly aggressive - nobody would do that today with what is known," said Dr. Neal Palafox, who headed the U.S.-funded program from 1998 until last December. "Even in those days it should have been done in a more conservative way. In effect, by taking out their thyroid, you're subjecting them to being hypothyroid all their lives and having to be on medication their whole lives."

Brookhaven scientists attributed any cancer risk to the initial exposure to the Bravo blast of 1954 and pointed out that most radioactive iodine - the element most likely to collect in human thyroids - had a half-life of only a few days. But others suggested the overall risk for cancer was aggravated by Brookhaven's decision, in 1957, to return hundreds of people to Rongelap, where, records show, they lived in contaminated conditions for nearly 30 years. Palafox said many surgeries on young patients were done without proper "informed consent."

In 2007, the Nuclear Claims Tribunal awarded Rongelap $1 billion in damages, including millions for being put to live in a contaminated environment. Tribunal records cite one physician who found 63.6 percent of male adults and 76.8 percent of females who were resettled in Rongelap suffered medical problems attributable to exposure to contamination.

Current Marshallese officials say the thyroid removals with cash payments exploited the radiation victims' vulnerability. "I think it's unethical, I think its racism, and taking advantage of poor people who were uneducated at the time," said James Matayoshi, Rongelap's current mayor.

Conard - who died in 2001 - and other BNL doctors later said the cancer threat came as a surprise. In its annual medical survey of the Marshallese in 1957, BNL's team found little reason for concern about the islanders' future health. Young children received "moderate doses" of radiation to their thyroids, said Brookhaven researchers, who predicted that "the probabilities are good" that no cancer problems would result from their exposure.

But a decade later, with many experiencing thyroid problems on Rongelap and surrounding atolls, BNL's view began to fall apart. Records show Conard questioned how radioactive contamination could seep into so many foods eaten by the Marshallese. So he decided to bring native food items such as pandanus fruit and coconut meat back to Brookhaven and eat them himself.

"I think there was something that struck him as not the way it should have been," recalled Chris Conard, his son. "And he probably felt the only way for him to come up with a proper set of data would have been to create a control situation, in which he put himself in line with the other people that had been exposed in this way. And to treat himself in that way and then study his own body."

Tests of Conard's urine and excrement over a 180-day period showed that the presence of strontium-90 in his body shot up to 20 times higher than normal, and cesium-137 was "60 times higher than normal," Conard later wrote in a memo. According to interviews with Marshallese and a review of records, Conard apparently never shared this information with the people who had been returned to Rongelap.

A 1973 report by the governments of Rongelap and nearby Utirik faulted Brookhaven for ignoring medical evidence that children exposed to radioactive particles were more likely to absorb this contamination in their thyroid glands than adults. The report states that BNL "never accounted for this factor until it was blatantly apparent" with the emergence of thyroid tumors.

"Consistently their reports have tended to minimize effects, or other aspects of the exposure; i.e., dosages seen as 'too small' to have any effect, the size of the group is 'too small' for statistical significance, effects are expected to be 'minimal' over a long period of time, and exposures are referred to as 'sub-lethal' rather than 'near-lethal,' " the report concluded.

Years later, Conard would write that those who received surgery were fully aware of what was going on. "We explained the need for this treatment and requested their consent," he said in a 1992 report.

A 1995 U.S. Presidential Advisory Committee on Human Radiation Experiments came to a different conclusion about BNL's treatment. "This inherent tension, coupled with the additional strains of language and cultural differences between the Marshall Islanders and the physicians, appears to have compromised the process of informing the subjects of the purpose of the tests and of obtaining their consent, which has doubtless contributed to their sense of being treated as guinea pigs," the committee wrote.

Dr. Robert McConnell, a thyroid expert at New York Presbyterian Hospital in Manhattan, said it is difficult today to second-guess the care given to the Marshall Islanders because medicine's understanding of radiation's effects was still developing. But he said the large number of thyroid cases that emerged should have been a warning of greater radiation danger than originally believed.

Most troublesome, McConnell said, was Brookhaven's decision to allow patients to return to Rongelap and other contaminated islands after the surgeries.

"Let's put it this way - if one of those Islanders were my patient, I would have counseled them that it was not prudent to move back after having their thyroids taken out for thyroid cancer," McConnell said. "They had already been exposed to excessive amounts of radiation."

A 1995 report by the Brookhaven team found that the "epidemic" of thyroid problems was "virtually over" and suggested that the numbers would soon be going down. Those assurances were contradicted by a 2004 National Cancer Institute report which projected that 40 percent of all radiation-related thyroid disease among nearly 14,000 Marshall Islanders exposed to radioactivity during the Cold War had yet to develop. Of the estimated 530 excess cancers caused by radiation exposure throughout this tiny nation, the NCI projected, an estimated 262 would be thyroid cancers.

Both McConnell and George Annas, chairman of the health law and bioethics department at Boston University's School of Public Health, said they've never heard of such a large sum of money being offered to patients considering surgery in a government-funded research program.

"The worry here is the exploitation factor - agreeing to something they wouldn't ordinarily agree to, and whether the only reasons why they did this was for the money," Annas said.