Friday, September 30, 2011

IOM “Veterans and Agent Orange: Update 2010” Released

The Veterans and Agent Orange: Update 2010 has just been released. It contains some disappointing information such as the lack of proof of a connection between dioxin and cancers of the mouth, esophagus, stomach, intestines, colon, etc...essentially the entire alimentary canal. But it also contains some suggestive comments about the DVA.

The study was performed by the National Academies of Science's Institute of Medicine, in its biennial review. The review in this case began in 2009 and ended in 2010. The reports are usually released in late summer, but this one may have been delayed by Senator James Webb's call for a review of the IOM's previous peer review and conclusions and recommendations based on the Australian Study that found a path to exposure through water contamination and the shipboard evaporation system of making fresh boiler and potable water.

This study was to cover the following:

A) whether a statistical association with herbicide exposure exists, taking into account the strength of the scientific evidence and the appropriateness of the statistical and epidemiological methods used to detect the association;
B) the increased risk of disease among those exposed to herbicides during service in the Republic of Vietnam during the Vietnam era; and
C) whether there exists a plausible biological mechanism or other evidence of a causal relationship between herbicide exposure and the disease.

The Committee is charged with, among other things:

In conducting its study, the present committee operated independently of the Department of Veterans Affairs (VA) and other government agencies. The committee was not asked to make and did not make judgments regarding specific cases in which individual Vietnam veterans have claimed injury from herbicide exposure. This report provides scientific information for the Secretary of Veterans Affairs to consider as VA exercises its responsibilities to Vietnam veterans. The committee was not charged to focus on broader issues, such as the potential costs of compensation for veterans or policies regarding such compensation.

In addition to the above charge, the VA made an additional request arising from the decision making at VA necessitated by the findings of Update 2008. The sponsor asked that, when summarizing the evidence available to support the association of a health effect with exposure to the components of the herbicides used by the military in Vietnam, the committee address whether or not all the points that have rather imprecisely become known as the Bradford Hill (1965) “criteria” for causality (strength, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, and analogy) had been satisfied by the information available.

The study made some recommendations, among them classifying specific diseases as to the relative likelihood of a causal connection between exposure to Dioxin/TCDD and the specific disease. They were ranked as:

Sufficient Evidence of an Association: Soft-tissue sarcoma (including heart), Non-Hodgkin lymphoma, Chronic lymphocytic leukemia (including hairy cell leukemia and other chronic B-cell leukemias), Hodgkin lymphoma, Chloracne.

Limited or Suggestive Evidence of an Association: Laryngeal cancer; Cancer of the lung, bronchus, or trachea; Prostate cancer; Multiple myeloma; AL amyloidosis; Early-onset peripheral neuropathy (category clarification from Update 2008); Parkinson disease; Porphyria cutanea tarda; Hypertension; Ischemic heart disease; Type 2 diabetes (mellitus); Spina bifida in offspring of exposed people.

Inadequate or Insufficient Evidence to Determine an Association.
Cancers of the oral cavity (including lips and tongue), pharynx (including tonsils), or nasal cavity(including ears and sinuses); Cancers of the pleura, mediastinum, and other unspecified sites in the respiratory system and intrathoracic organs; Esophageal cancer; Stomach cancer; Colorectal cancer (including small intestine and anus); Hepatobiliary cancers (liver, gallbladder, and bile ducts); Pancreatic cancer; Bone and joint cancer; Melanoma; Nonmelanoma skin cancer (basal cell and squamous cell); Breast cancer; Cancers of reproductive organs (cervix, uterus, ovary, testes, and penis; excluding prostate); Urinary bladder cancer; Renal cancer (kidney and renal pelvis); Cancers of brain and nervous system (including eye); Endocrine cancers (thyroid, thymus, and other endocrine organs); Leukemia (other than all chronic B-cell leukemias, including chronic lymphocytic leukemia and hairy cell leukemia); Cancers at other and unspecified sites; Infertility; Spontaneous abortion (other than after paternal exposure to TCDD, which appears not to be associated); Neonatal or infant death and stillbirth in offspring of exposed people; Low birth weight in offspring of exposed people; Birth defects (other than spina bifida) in offspring of exposed people; Childhood cancer (including acute myeloid leukemia) in offspring of exposed people; Neurobehavioral disorders (cognitive and neuropsychiatric); Neurodegenerative diseases, excluding Parkinson disease; Chronic peripheral nervous system disorders; Hearing loss (newly addressed health outcome); Respiratory disorders (wheeze or asthma, chronic obstructive pulmonary disease, and farmer’s lung); Gastrointestinal, metabolic, and digestive disorders (changes in hepatic enzymes, lipid abnormalities, and ulcers); Immune system disorders (immune suppression, allergy, and autoimmunity); Circulatory disorders (other than hypertension and ischemic heart disease); Endometriosis Effects on thyroid homeostasis; Eye problems (newly addressed health outcome); Bone conditions (newly addressed health outcome).
Please note that most of these indicate a direct causal relationship, and not an indirect one. For example, Diabetes Mellitus Type 2 often has associated peripheral nerve damage and eye problems, and coverage for those situations is included under the DVA's current Agent Orange policies.

Despite the assertions by the staff of Senator Webb to the contrary, the Institute of Medicine does indeed make recommendations to the DVA. In fact, that is specifically what these studies are all about. Accordingly, the IOM essentially calls for increased studies, including:

This committee recommends that the VA should more actively query their own medical databases to identify potential associations between Vietnam service and specific health outcomes, particularly for those outcomes that are less common. Moreover, if a perceived conflict of interest exists in surveying their own databases, it is recommended that an external advisory group be formed to determine the best mechanism for mining this information so that these medical databases could be available for external study.

The committee for Update 2008 concluded that it was plausible that exposure to the herbicides sprayed in Vietnam could cause paternally-mediated effects in offspring as a result of epigenetic changes and such potential would most likely be attributable to the TCDD contaminant in Agent Orange. There is a growing body of evidence that TCDD, and also arsenicals, can induce epigenetic changes in animal models, but there remains extremely limited data on the risk of paternal exposure to xenobiotics in general, and the VAO chemicals of interest in particular, resulting in adverse effects on their offspring. Consequently, this committee continues to recommend that laboratory research be conducted to characterize TCDD’s potential for inducing epigenetic modifications. Further, the committee recommends development of epidemiologic protocols to address the logistical challenge of determining whether adverse effects are being manifested in the adult children and grandchildren of Vietnam veterans as a result of paternal exposure. The best cohorts for revealing potential associations would be those with known, well-characterized exposure information. Another alternative would be to adopt a case-control approach and explore whether information about Vietnam exposure or specific herbicide exposure could be ascertained in any of the many birth cohorts that have been established in the past several decades. To hone in on a paternal effect, however, it will be necessary to establish that the mothers did not have the opportunity for exposure above background levels to the chemicals of interest.

As in previous years, this committee recommends the pursuit of additional research in toxicology. The development of animal models of various chronic health conditions and their progression would be useful for understanding the possible contributions of the chemicals of interest to compromise the health of aging Vietnam veterans. Specifically, determining the mechanism by which dioxin-like chemicals induce B cell cancers and how this exposure alters the susceptibility to developing obesity and components of metabolic syndrome would fill important knowledge gaps. Additional health problems, such as metabolic syndrome, COPD, and measuring meaningful biomarkers of immune/inflammatory disease merit study in human populations.

The committee notes that the earlier investment in studying several exposed populations is now producing useful findings; the National Institute for Occupational Safety and Health, Seveso, Air Force Health Study, and Army Chemical Corps cohorts all merit continuing follow-up or more comprehensive analysis. It is especially important that longitudinal analyses be conducted on cancer, cardiovascular, and reproductive outcomes represented in the complete database assembled in the course of the Air Force Health Study. The committee endorses VA’s actions toward restarting the congressionally mandated National Vietnam Veterans Longitudinal Study, derived from the cohort originally studied in the National Vietnam Veterans Readjustment Study.

The committee notes that its recommendations are similar to those offered in previous
updates and that there has been little activity in several critical areas. The fate of the assemblage of data and biologic samples from the Air Force Health Study remains unsettled; in the interim, critical integrative analyses such as longitudinal evaluation of the cancer data have not yet been made public, and the unique potential of this resource languishes. It is the committee’s conviction that work needs to be undertaken promptly to resolve questions regarding several health outcomes, importantly COPD, tonsil cancer, melanoma, Alzheimer disease, and paternally transmitted effects to their offspring. Creative analysis of VA’s own data resources and further work on cohorts that have already been established may well be the most effective way to address those outcomes and to gain a better understanding of the role of herbicide exposure in development of Parkinson’s Disease in Vietnam veterans.

You can read or download the report at the following link. Downloads in Adobe .pdf format are free.

http://www.iom.edu/Reports/2011/Veterans-and-Agent-Orange-Update-2010.aspx

We will assess this study tomorrow and post that assessment tomorrow evening.

VNVets

”It is a stain on this nation's honor that the Department of Veterans Affairs has become a deadlier and more difficult adversary to the American veteran than any they have ever faced on a battlefield."-- VNVets

"The concept that Agent Orange, and its effects, stopped dead in its tracks at the shoreline is simply too illogical, and too ludicrous to accept. What does that say about the Obama Administration and his Department of Veterans Affairs?"--VNVets

"With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations." --President Abraham Lincoln

"It follows then as certain as that night succeeds the day, that without a decisive naval force we can do nothing definitive, and with it, everything honorable and glorious."--President George Washington

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5 comments:

  1. Stephen K. Amy20:13

    The USS Theodore E. Chandler DD717 should be on the list of ships that operated also in BROWN WATER. An officer Ltjg James Kennedy who came aboard about the same time that I did, Has photos of Nha Trang harbor when were there on several occassions in 1965. I have his sworn statement and photos. We were often tied up along other docked ships there. The only two people I've contacted both had cancer! Stephen K. Amy ETR3, 7731271. Ltjg James Kennedy and ET Leo Belovith.

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  2. Not sure what you want us to do here. If you have evidence, you should go through your congressional representative or your senator and have their staff present COPIES of such evidence to the VA's Compensation and Pension bureau at VA HQ in Washington.
    If you have any questions contact me directly using the “email me” link near the top of the left column.

    VNVets

    ReplyDelete
  3. Anonymous07:28

    Alert...
    claim of exposure to agent orange....as of Jan 2012... Richard B Anderson-dd786 has been added to the list...please spread the word and start filing your claims


    Thanks

    ReplyDelete
  4. Anonymous00:38

    Husband just diagnosed with esophageal cancer. Other than this, a very healthy 65 year old that served on the Arnold J Isbell (1966-67 Vietnam) -- not sure what to think right now.

    ReplyDelete
  5. Hank Sipple19:18

    Served aboard USS Holder (DD-819) Sep 1965- Jul 1968. Vietnam 1966-67. Diagnosed Hypothyroid 1989 currently receiving 10% VA Disability. WOW...

    ReplyDelete