The hearts and minds of people in Hawaii empathize with the profound suffering of our neighbors in Japan. Few places are as bonded to Japan as the islands. We share memories of the bombing of Pearl Harbor and of the A-bombs dropped on Hiro­shima and Naga­saki. We cry when we hear the stories of the nissei who expressed their American patriotism by serving in the 442nd while so many of their friends and families were still in internment camps.

The economic fate of Hawaii is always intertwined with Japan, beginning with the plantation days when poor immigrants came seeking a better life. We recall the late ’80s, before the property bubble burst, and stories of Japa­nese businessmen ringing doorbells in Kahala and Portlock offering briefcases of cash for a quick sale. The visitor industry which we live and die by never takes its eye off the Japa­nese numbers. We wilted when they took pause after Sept. 11, 2001.

In lamenting the rolling disaster with patients this week, several cast their eyes toward the ground and simply mumbled, "Hell on earth." How much can one people take? A massive earthquake, followed by a wall of water carrying bodies, buildings and ships miles from the coast crushing picture-perfect fields, defies the imagination. As though that devastation were not enough, the entire world has been riveted by a nuclear crisis with several reactors at risk as primary and secondary cooling systems failed. We saw footage of explosions with smoke and steam as teams resorted to using helicopters and water cannons to prevent a total core melt down.

We struggle to accurately assess the health and economic risks to the people of Hawaii. We balance partial disclosure and underreporting from the Japa­nese government with media that tend to sensationalize. Unless there is a confirmed report of a complete core meltdown, the risk of dangerous fallout in Hawaii is not great. To the extent that nuclear radiation is released into the atmosphere, weather, including high or low pressure and wind direction, obviously becomes the key variable. In any case our great distance from Japan is a significant mitigating factor even in the worst case.

The current run on iodine products is somewhat misguided. Iodine is only one of several radioactive isotopes that might be released, and it has a short half-life. It does help prevent thyroid cancer from radioactive iodine but does not prevent other ill effects of radiation. Aside from potassium iodide, miso and all types of limu are quite rich in this nutrient.

Concern about how much radiation is released from damaged reactors will have an endpoint in the very near term. Debates about the safety of nuclear energy, however, are approaching a crescendo. Governments throughout the globe have ordered stress tests, safety reviews and strategic re-evaluation of energy policy. The debate is intensified by popular uprisings in oil-rich countries throughout the Middle East and North Africa, with Libya hanging in the balance.

Global insecurity stemming from the crises in Japan combined with "supply shock" hit the markets hard this week. Automotive and other manufacturers have had to shut down for now, but the global recovery is likely to continue its momentum. Gripping questions on energy policy, climate change and public safety will remain at the forefront.

Japan will be forever changed by the earthquake and its aftermath.

In time the nuclear power plants will be under control, the aftershocks should taper and the half-million displaced Japa­nese will need new homes. Construction and materials companies will see powerful demand for some time. Some of those who can will purchase homes in Hawaii.

Most important, the spirit of the Japa­nese people has an opportunity to rise again as a phoenix from the ashes. The Japa­nese miracle following World War II awed the world, but the nation has languished for the past 20 years. The fate of Hawaii remains closely tied to the spirit of the recovery in Japan.

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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.