Chapter 12: A Brookhaven Laboratory Study in the Marshall Islands

Chapter 12: A Brookhaven Laboratory Study in the Marshall Islands

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Description

In this chapter Dr. Hill speaks about his involvement (and that of other MD Anderson personnel) with the Brookhaven National Laboratory studies of the effects of nuclear fallout in the Marshall Islands. He describes his work with patients in the Islands. He then talks about how MD Anderson became an important treatment center for thyroid cancer because of the use of the “avant garde therapy” of radioactive iodine, noting that Dr. Clark was responsible for bringing the significant researchers together.

Identifier

HillCS_03_20120220_C012

Publication Date

2-20-2012

City

Houston, Texas

Topics Covered

The Interview Subject's Story - The Researcher; The Researcher; Activities Outside Institution; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care

Transcript

You started to tell me about a project in the Marshall Islands?

C. Stratton Hill, MD:

Yeah, the person who was the first Chief of Pediatrics at MD Anderson was Grant Taylor. Did you ever hear anything about him?

Tacey Ann Rosolowski, PhD:

No.

C. Stratton Hill, MD:

Just sort of a general question—

Tacey Ann Rosolowski, PhD:

If I could just interrupt us for a second because I’m noticing that this leaf is really creaky, and maybe we could just move to a slightly more stable part of the table. Can I scoot this? Great, because I know all of that sound will read on the recorder. It can make life very difficult for people, sound editors. All right, great. All right, so you were saying Grant Taylor who was—

C. Stratton Hill, MD:

Well, I’m not real sure about his background. However, he was in World War II, and I know that he was very much involved with what was at that time called Atomic Energy Commission. He had to do with the studies in Japan relating to the atomic bomb dropping there. And coming out of that from Brookhaven National Laboratory on Long Island was a study relating to the atomic bomb testing that the US did in the Marshall Islands in Bikini and Enewetak. That kind of a natural experiment was formed by the fact that the wind shifted unexpectedly, and it blew radioactivity over some of the smaller islands in the archipelago, and some people were exposed where others weren’t. For instance, the two islands were Utrik and Rongelap. The wind shifted and blew over those little islands. They’re very small. The men were out fishing, so they did not get exposed to the radiation. So you had a fairly uniform population, except for gender, that was exposed and the part that was not exposed, so it was kind of a natural experiment. The beginning of the Atomic Energy Commission began to follow people, the inhabitants of those islands. There weren’t very many, like 400 or 500 people, so then it became the Department of Energy, Each year a group of physicians was selected from various parts of the United States to go out there and do this examination.

Tacey Ann Rosolowski, PhD:

When did this start?

C. Stratton Hill, MD:

I really don’t know. I suspect if you pulled up Brookhaven and the Marshall Island study on Google that that might be in it. As a matter of fact, I think maybe I have a book on it. I’ll look to see, and if it’s in there, I’ll give you a call. You can have it and take a look at it because I know of— I’m pretty sure that Dr. Taylor went out there and then Dr.—his name was Watu or Wataru or something—[Wataru] Sutow, S-U-T-O-W. He was Chinese, and Dr. Patricia Sullivan. Dr. Sutow and Dr. Sullivan were pediatricians. I went out there about 1980-’82, some time in there.

Tacey Ann Rosolowski, PhD:

So this was really a longitudinal study.

C. Stratton Hill, MD:

Oh, yeah. It was really longitudinal. It may still be going on. I don’t know. That was something that would be of interest that MD Anderson physicians did, participate in that study.

Tacey Ann Rosolowski, PhD:

What did you do when you went there?

C. Stratton Hill, MD:

Well, what we did was we went to Kwajalein. Kwajalein was the main base in the Marshall Islands. There was a huge battle during World War II of Kwajalein, and so it belonged to the Japanese. As a matter of fact, that’s where the Japanese fleet stopped to refuel on the way to Pearl Harbor. The island is a speck in the ocean, and it took the—I’m told, and I saw some of the pictures out there, and there’s a book on it, I think—it took the US—I don’t know—Sixth Fleet or something, whatever it was, about a week bombardment. It’s almost like bombarding an acre of land, or maybe two or three acres of land, for a week, with major battleships. What the Japanese had done was to say to these guys “You’re there, and we’re gone, and remember that the Americans are cannibals. They eat people. So it’s up to you to fend them off.” Well, it took them about a week, and then I think the Sixth Army invaded, and it took them about a week to take these little—because they were dug in like crazy, and the only thing you got to dig in was the coral. It was just a coral reef on top of a volcano. We went on a ship from Kwajalein to these two islands, Rongelap and Utrik, and we anchored in the lagoon. Then we would bring the people on board to examine and take them back. It was a ferry-type of procedure. We had two little Boston whalers, and we went back and picked them up and so forth.

Tacey Ann Rosolowski, PhD:

And what did you observe medically with these people?

C. Stratton Hill, MD:

I was to examine the thyroid because the radioactive iodine was the thing that had poisoned the water on the island that the women and children were exposed to, and we had— I can’t remember the surgeon’s name. I knew him real well. He was from the Cleveland Clinic. What was his name? Anyway, he came out while we were there, and he’d been out there before, too. We would take those people, and if we found some abnormality, we then brought them back to the US for treatment. And we found a couple of people. We found one woman that had hyperthyroidism, so she went back to the Cleveland Clinic to be treated. Then they had found two or three cases of thyroid cancer, which in that population would be significant because it’s such a small population. You wouldn’t think any people would have it. That was the whole purpose, to see a long-term linear study as to what effect that fallout of radiation had.

Tacey Ann Rosolowski, PhD:

And did you collaborate or individually publish any findings based on this?

C. Stratton Hill, MD:

Well, no. I didn’t. In other words, I’m pretty sure it was published, and maybe what I’ve got is an interim report. I don’t know how often they did reporting. I was not involved in the planning of it. It was just they needed some manpower, and so I just went out there and did it.

Tacey Ann Rosolowski, PhD:

Was it a volunteer kind of thing, or were you selected?

C. Stratton Hill, MD:

I was selected. You had to be selected.

Tacey Ann Rosolowski, PhD:

And what were the criteria they used for selection?

C. Stratton Hill, MD:

I just got a phone call. They said, “We want you to come.” Whatever it was, I didn’t apply. I didn’t do anything, so whatever it was, I guess I fit it. It was all in conjunction with a lot of other stuff. The ship that we were on—and I use that term loosely, when I say ship—it was a converted garbage scow. I don’t know if you know what a garbage scow is. I didn’t know what a garbage scow was. But whenever the fleet would be in like at Pearl Harbor or in port, they had a garbage scow that would go up under the bow or the stern or someplace, and it was kind of like flushing the commode. All of the garbage would come out, and this container of ship—it was just an open hull of a ship—and it would fall in that. They’d take it out in the ocean and dump it out. Some entrepreneur from Los Angeles had bought some of those things, and they were never intended to go to sea. He then converted it to the clinic. They put a big boom on it that we could lift things off and on the ship, and we had kind of a clinic built on there. It took us about a day to get out to these islands from Kwajalein, and we stayed out there a month, and it was very interesting. I was convinced that the world was flat because you couldn’t see anything except water.

Tacey Ann Rosolowski, PhD:

Was there anything in particular you learned from that experience for your own practice?

C. Stratton Hill, MD:

Well, one of the things that I thought I would do is to see if—see, these people are—this is really Micronesia, and so the natives are black, but they don’t have the negroid characteristics of big, thick lips. They really have Anglo characteristics physiognomy-wise and anthropologically-wise. On the way out there, I remember I was so busy at the hospital that this all—I mean—it suddenly was on me. My children were small, and my wife just stayed here with the children. So we made all those kinds of arrangements. So I thought, “Boy, here I am. I’m leaving in the morning.” We flew to Honolulu, and it was a couple of days there. I got on the telephone. I looked up in the telephone book the Department of Anthropology at the University of Hawaii, and they had listed there Pacific Island Study Group, so I called it up. I called up that number, told the secretary who I was and what I was doing and that I’d like to talk to a faculty member. This guy answers the phone, and I told him. And he said, “How long are you going to be here?” I said, “Well, we’re leaving the day after tomorrow.” He said, “If you can come here tomorrow, I’m going to give you a crash course in Pacific Island anthropology,” so I said, “Okay.” I went out there, and he did. I just sat down, and I got a 101 course, and it was extremely helpful because he explained to me that this was a matrilineal society, that everything came through the female, but that it was executed by the male. The female told what the action would be, and it was like it had to be a blood relative. It couldn’t be a woman’s husband. It had to be her brother. And they had a queen, and they had hierarchy. She decided what would be done, and her brother, if she had one, would be the one that would carry that out. In addition, I found out that they divide things up by what they call kitchens. I don’t know what they called them in Marshallese. Marshallese is not a written language. It may be now. See, they became a country after we gave them up, but at the time that I was there, they were a protectorate. It’s just a small, small atoll, and the kids run around naked all the time, and I’m sure the girls get pregnant as soon as they became sexually mature. So children belong to a kitchen.

Tacey Ann Rosolowski, PhD:

I’m not sure I’m getting that word right. Is it kitcha?

C. Stratton Hill, MD:

Kitchen.

Tacey Ann Rosolowski, PhD:

O Oh, like a kitchen. Oh, okay. Gotcha. How was this cultural information useful to you?

C. Stratton Hill, MD:

It wasn’t. It just made me understand. I mean, it didn’t have anything to do with— I mean, you could say this was strictly trial marriages. They lived together, and they may have three or four kids, and they say, “Now I don’t want to get married. I don’t want to marry you.”

Tacey Ann Rosolowski, PhD:

It’s pretty fluid.

C. Stratton Hill, MD:

Yeah, and that’s the reason why— And every woman was called a mother because if she couldn’t get pregnant they’d give her a child. But all the children knew who the mother was, but then they knew who the effective mother was that they belonged to also. It was really a— I’m told that that’s changed somewhat. As a matter of fact, on Kwajalein, there was another little atoll close by. At low tide, you could walk across the coral to the next island, and it was called Ebeye. Out there, they also had extended families. So if somebody had a job, like at the base on Kwajalein, a family member from Rongelap or Utrik, one of those islands, might come over and live, and you took them in. That was the custom, so they had a whole bunch of people over there on Ebeye. They wouldn’t let anybody on Ebeye be on Kwajalein after dark unless they worked at the thing.

Tacey Ann Rosolowski, PhD:

You mentioned that there were some certain things that you wanted to look at when you were there. Did you—? What were those in terms of your cancer work?

C. Stratton Hill, MD:

I thought that— The thyroid gland is in one of the gills, and it migrates through the thyroglossal duct into the anterior portion of the neck. If that migration goes awry, the thyroid can be anywhere. You can have a thyroid gland in the mouth. We’ve had people sent to Anderson that said they had a tumor on their tongue, and it was a lingual thyroid. You could look through there, and there’d be a lump up there, and that was the thyroid gland. It wasn’t bothering you. Most people just thought, “I can’t stand it. I’ve got to get that out.” But it would be okay.

Tacey Ann Rosolowski, PhD:

And it’s doing its job.

C. Stratton Hill, MD:

It was doing its job until somebody, maybe a dentist, looked in there and said, “My gosh, you’ve got this.” You may read that the thyroid gland can occur in the mouth, but nobody really sees enough of it. I thought, “Well, why don’t I just examine all of these people to see if any of them had a lingual thyroid or if by some chance it was some genetic thing.” It turns out not a single one of them did, but I got the reputation from the islanders that I was going to stick my finger down their throat. They didn’t know who I was, but I was the doctor that would stick his finger down your throat. That didn’t pan out to be of any significance, but it’s just interesting that at Anderson doctors participated in that. That’s all I wanted to do. Those are the three people that I knew who were involved, Grant Taylor, who was the epitome of the Spanish don, I would say, from Barcelona. He was a true gentleman, a Renaissance man of the highest order.

Tacey Ann Rosolowski, PhD:

And was the fact that a number of MD Anderson doctors were invited to take part in this [the Brookhaven National Laboratory study in the Marshall Islands] —was that an indication of the increasing prestige of the cancer center?

C. Stratton Hill, MD:

I think so. I think definitely because, see, the reason why this became a prominent thyroid center was that Dr. Clark was interested in the surgery of the thyroid. Dr. Kelsey was an endocrinologist, and he was trained at the Mayo Clinic. He was qualified to use radioactive iodine, so since that was a very early utilization of, let’s say, avant-garde therapy— We were the only ones around that had radioactive iodine, and so a lot of thyroid cases got referred to Anderson. It didn’t make any difference if it was a tumor or not. A lot of them were thyroid nodules, both benign and malignant, and just thyroid disorders in general. We began publishing, also, on the whole organ section that they were doing, things like that.

Tacey Ann Rosolowski, PhD:

I’m not sure I understand what that phrase means, whole organ section. What does that refer to?

C. Stratton Hill, MD:

That means if you take a tumor out of a lung, you just take the tumor out of the lung. If you did a whole organ section of the lung, you’d do the whole lung.

Tacey Ann Rosolowski, PhD:

I gotcha. Okay.

C. Stratton Hill, MD:

This was the whole thyroid gland. They were saying—the story that I get was, okay, the way they did this as therapy originally was if you had a lobe thyroid— Do you know what the shape of the thyroid is? It’s kind of like a butterfly, so each side is called a lobe, and then the part that goes in the middle is called the isthmus. If you had a nodule over on the right lobe, just the right lobe was removed. They began to see, well, wait a minute. We took the right lobe out last year, and this year we’re taking the left lobe out. Why don’t we just take all of it out at the beginning? And so they were doing a study to see how often there was a tumor in other parts of the gland. In order to do that, you had to have the whole lobe. If you did whole organ sections of the lung, you’d have to have a big plate to put that on, and you’d have to have a big (???)tomo-section-type of thing, a (???)tomometer or something, whatever they call it. It cuts these things very thin. You embed them in paraffin. You know how to do that. What they did then, they said, “Okay, we’re going to start taking the whole lobe, whole thyroid out.” The problem with that is the parathyroid glands are right behind, attached to the thyroid gland, and there are four of them. And if you just look at them real hard, they just up and die. The blood supply is so fragile. And of course, then we were seeing a lot of cases of hypoparathyroidism with the total thyroidectomy because the surgeons there— Dr. Clark was saying “Okay, now, we’re going to do a careful extracapsular dissection so we don’t disturb the parathyroids.” But it was almost impossible not to disturb them, so we had a high incidence of hypoparathyroidism. Now they do an intracapsular dissection to prevent that from happening and then too— Now I’m not sure what they’re doing, because of radioactive iodine. You can then ablate the rest of that with radioactive iodine and get rid of any tissue that you’ve got remaining. That’s sort of that epic in our history there of thyroid diseases with the ones in the Marshall Islands added. And Dr. Taylor is dead, Sutow is dead, [REDACTED]

Tacey Ann Rosolowski, PhD:

That’s going to be the end of an era.

C. Stratton Hill, MD:

That’s right.

Tacey Ann Rosolowski, PhD:

Last time we were— I’m sorry. Did you want to make any other statements about that?

C. Stratton Hill, MD:

No, I guess not. I think that’s about all. Dr. Clark is the one that assembled all these people together. Well, I don’t know about—I mean—the heads of the departments. He’s the one that got Grant Taylor here, and then I’m sure Grant Taylor probably brought these other guys, Sutow and Pat Sullivan and the group of people that were pediatricians and so forth.

Conditions Governing Access

Redacted

Chapter 12: A Brookhaven Laboratory Study in the Marshall Islands

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