Veterans and Agent Orange : health effects of herbicides used in Vietnam / Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides, Division of Health Promotion and Disease Prevention, Institute of Medicine.

Format:

Book

Author/Creator:

Institute of Medicine (U.S.). Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides.

Language:

English

Subjects (All):

Agent Orange--Health aspects.

Agent Orange.

Agent Orange--Toxicology.

Vietnam War, 1961-1975--Veterans--Health risk assessment--United States.

Vietnam War, 1961-1975.

Physical Description:

1 online resource (832 p.)

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, 1994.

Language Note:

English

Summary:

Have U.S. military personnel experienced health problems from being exposed to Agent Orange, its dioxin contaminants, and other herbicides used in Vietnam? This definitive volume summarizes the strength of the evidence associating exposure during Vietnam service with cancer and other health effects and presents conclusions from an expert panel. Veterans and Agent Orange provides a historical review of the issue, examines studies of populations, in addition to Vietnam veterans, environmentally and occupationally exposed to herbicides and dioxin, and discusses problems in study methodology. The core of the book presents What is known about the toxicology of the herbicides used in greatest quantities in Vietnam. What is known about assessing exposure to herbicides and dioxin. What can be determined from the wide range of epidemiological studies conducted by different authorities. What is known about the relationship between exposure to herbicides and dioxin, and cancer, reproductive effects, neurobehavioral disorders, and other health effects. The book describes research areas of continuing concern and offers recommendations for further research on the health effects of Agent Orange exposure among Vietnam veterans. This volume will be critically important to both policymakers and physicians in the federal government, Vietnam veterans and their families, veterans organizations, researchers, and health professionals.

Contents:

Veterans and Agent Orange

Copyright

Foreword

Preface

CONDUCT OF THE STUDY

Contents

1 Executive Summary

ORGANIZATION AND FRAMEWORK

CONCLUSIONS ABOUT HEALTH OUTCOMES

Health Outcomes with Sufficient Evidence of an Association

Health Outcomes with Limited/Suggestive Evidence of an Association

Health Outcomes with Limited/Suggestive Evidence of No Association

Health Outcomes with Inadequate/Insufficient Evidence to Determine Whether an Association Exists

Increased Risk in Vietnam Veterans

RESEARCH RECOMMENDATIONS

Epidemiologic Studies of Vietnam Veterans

Mandated Research Efforts

REFERENCES

2 History of the Controversy Over the Use of Herbicides

MILITARY USE OF HERBICIDES IN VIETNAM

Herbicide Development and Testing

Use of Herbicides in Vietnam

EARLY CONCERNS ABOUT THE USE OF HERBICIDES IN VIETNAM

Early Accounts of Dioxin (TCDD)

Concerns Over the Long-Term Use of Herbicides

CONCERNS ABOUT EXPOSURE TO AGENT ORANGE

Vietnam Veterans Return Home

The Beginning of the Controversy

AGENT ORANGE PRODUCT LIABILITY LITIGATION

Class Action Suit

CONCERNS ABOUT OTHER EXPOSURES TO 2,4,5-T AND TCDD

Occupational Exposure

Production Workers

Agricultural and Forestry Workers

Pulp and Paper Mill Workers

Major Event Associated with Occupational Exposure to Dioxin (TCDD)

Environmental Exposures

Domestic Use of Herbicides

Major Events Associated with Environmental Exposure to Dioxin (TCDD)

THE FEDERAL GOVERNMENT'S RESPONSE TO PUBLIC CONCERNS

White House

U.S. Congress

Hearings

Legislation on Agent Orange

Office of Technology Assessment

General Accounting Office

Department of the Air Force

Department of Veterans Affairs

Health Care

Research Efforts

Compensation and Benefits

Outreach Activities.

Department of Health and Human Services

Centers for Disease Control

Environmental Protection Agency

RESPONSE BY OTHERS TO PUBLIC CONCERNS

State Governments

Veterans' Advocates

Australia and South Korea

National Research Council and Institute of Medicine

3 The U.S. Military and the Herbicide Program in Vietnam

MILITARY AND DEMOGRAPHIC CHARACTERISTICS OF VIETNAM VETERANS

Estimates of the Number of Military Personnel Serving in Vietnam

Federal Estimates

Other Survey Estimates

Military and Demographic Characteristics

Studies of Women Veterans

THE MILITARY USE OF HERBICIDES IN VIETNAM

Operation Ranch Hand

Herbicide Formulations

Military Herbicides

Level of Toxic Contaminants

Termination of the Program

Disposal of Surplus Herbicides

Ground Spraying of Herbicides

The HERBS and Services HERBS Tapes

Geographical Distribution of Herbicide Sprays

SUMMARY

4 Toxicology

OVERVIEW

Chemistry

Exposure and Metabolism

Carcinogenicity: TCDD

Mechanism of Action

Carcinogenicity: Herbicides

Immunotoxicity: TCDD

Immunotoxicity: Herbicides

Reproductive and Developmental Toxicity: TCDD

Reproductive and Developmental Toxicity: Herbicides

Other Toxicity: TCDD

Other Toxicity: Herbicides

TOXICITY PROFILE OF TETRACHLORODIBENZO-P-DIOXIN

Introduction

Exposure and Pharmacokinetics

Bioavailability Following Various Routes of Exposure

Distribution

Metabolism

Excretion

Ah Receptor

Non-Ah-Mediated Toxicity

Health Outcomes in Animal Studies

Carcinogenicity

Immunotoxicity

Hepatotoxicity

Reproductive and Developmental Toxicity

Reproductive Toxicity

Neurotoxicity

Metabolic Toxicity.

Gastrointestinal Toxicity

Respiratory Tract Associated Toxicity

Cardiovascular Toxicity

Corticosteroids

Dermal Toxicity

TOXICITY PROFILE OF 2,4-DICHLOROPHENOXYACETIC ACID

Pharmacokinetics

Genotoxicity

Acute Toxicity

Chronic Systemic Toxicity

TOXICITY PROFILE OF 2,4,5-TRICHLOROPHENOXYACETIC ACID

TOXICITY PROFILE OF CACODYLIC ACID

TOXICITY PROFILE OF PICLORAM

5 Methodologic Considerations in Evaluating the Evidence

QUESTIONS TO BE ADDRESSED

Are Herbicides Statistically Associated with the Health Outcome?

What Is the Increased Risk of the Disease in Question Among Those Exposed to Herbicides in Vietnam?

BURDEN OF PROOF

CATEGORIES OF EVIDENCE

Experiments in Humans: Randomized Controlled Trials

Experiments in Animals: Animal Models

Controlled Epidemiologic Studies (Observational)

Cohort Studies

Proportionate Mortality Studies

Case-Control Studies

Case Reports and Case Series

Information from Death Certificates

Integration of Collective Results

Meta-Analysis

Considerations in Assessing the Strength of Scientific Evidence

Strength of Association

Dose-Response Relation

Temporally Correct Association

Consistency of Association.

Specificity of Association

Biologic Plausibility

Other Considerations

The Role of Studies of Occupational and Environmental Exposures

NATURE OF THE CONCLUSIONS

Quantification

Resolution

Uncertainty and Confidence

Qualitative Aspects of the Review Process

Comprehensiveness

Neutrality

Judgment

SUMMARY OF THE EVIDENCE

Categories of Association

6 Exposure Assessment

AN OVERVIEW OF EXPOSURE ASSESSMENT FOR EPIDEMIOLOGY

Hierarchy of Exposure Assessment Strategies

Exposure Assessment for Cohort Studies

Exposure Assessment for Case-Control Studies

Exposure Misclassification

Biomarkers

Biomarkers for TCDD

Chloracne as a Biomarker

EXPOSURE ASSESSMENT IN OCCUPATIONAL AND ENVIRONMENTAL STUDIES

Occupational Studies

Agricultural/Forestry Workers

Herbicide/Pesticide Applicators

Paper and Pulp Mill Workers

Environmental Studies

Vietnamese Studies

Conclusions on Exposure Assessment in Occupational and Environmental Studies

EXPOSURE ASSESSMENT IN STUDIES OF VIETNAM VETERANS

Self-Reports

Records-Based Measures

Vietnam Service

Branch of Service

Combat Experience

Military Occupation

Reconstructing Estimated Exposure from Troop Location and Herbicide Spray Data

The CDC Exposure Opportunity Index

The CDC Agent Orange Study

The Stellmans' Study

Ranch Hand Exposure Index

Biomarkers of Exposure in Vietnam

CDC Agent Orange Validation Study (AOVS)

ESTIMATES OF EXPOSURE TO HERBICIDES AND TCDD DURING VIETNAM SERVICE

EXPOSURE RECONSTRUCTION

Development of the Exposure Reconstruction Model

Evaluation of the Exposure Reconstruction Model

7 Epidemiologic Studies

OCCUPATIONAL STUDIES

Production Workers.

National Institute for Occupational Safety and Health

Monsanto

Dow

BASF

Other Chemical Plants

Paper/Pulp Workers

Other Occupational Studies

ENVIRONMENTAL STUDIES

Seveso

Times Beach and Quail Run

Vietnam

Other Environmental Studies

VIETNAM VETERAN STUDIES

United States

Ranch Hands

American Legion

State Studies

Other U.S. Vietnam Veteran Studies

Australia

8 Cancer

CANCER EPIDEMIOLOGY

SPECIFIC ISSUES WITH REGARD TO HERBICIDE EXPOSURE IN VIETNAM

EXPOSURE

PLAUSIBILITY DATA

EXPECTED NUMBER OF CANCER CASES AMONG VIETNAM VETERANS

OVERALL CANCER

Background

Epidemiologic Studies

Vietnam Veterans Studies

Summary

GASTROINTESTINAL TRACT TUMORS

Conclusions

Strength of Evidence in Epidemiologic Studies

Increased Risk of Disease Among Vietnam Veterans

HEPATOBILIARY CANCERS

NASAL/NASOPHARYNGEAL CANCER

RESPIRATORY CANCERS

Epidemiologic Studies of Laryngeal Cancer

Conclusions.

Strength of Evidence in Epidemiologic Studies.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references and index.

ISBN:

9786610196432

9781280196430

1280196432

9780309556194

0309556198

9780585027135

0585027137

OCLC:

42329279