Saturday, December 07, 2013

Just in: IOM Veterans and Agent Orange: Update 2012

The Institute of Medicine has released its ninth biennial update report on Veterans and Agent Orange recently.  Here are the relevant sections as pertain to Blue Water Navy Veterans [link to download the 800 page + pdf can be found at the bottom of this post]: 
 
IOM Veterans and Agent Orange: Update 2012 

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Increased Risk in Vietnam Veterans
When all the available epidemiologic evidence has been evaluated, it is presumed that Vietnam veterans are at increased risk for a specific health outcome if there is evidence of a positive association between one or more of the COIs and the outcome. The best measure of potency for the quantification of risk to veterans would be the rate of the outcome in exposed Vietnam veterans compared with the rate in nonexposed veterans, adjusted for the degree to which any other factors that differ between exposed and nonexposed veterans might influence those rates. Conley and Heerwig (2012) have noted, however, that elements of bias may have been involved in the selection of service members for deployment. A dose–response relationship established in another human population suitably adjusted for such factors would be similarly suitable.

It is difficult to quantify risk when exposures of a population have not been measured accurately. Recent serum TCDD concentrations are available only for subgroups enrolled in the Air Force Health Study (AFHS) (the Ranch Hand veterans and Southeast Asia comparison subjects) and from VA’s study of deployed and nondeployed members of the Army Chemical Corps. Pharmacokinetic models, with their own set of assumptions, must be applied to extrapolate from contemporary readings to obtain presumably accurate estimates of original exposure of Vietnam-era veterans. The absence of reliable measures of exposure of Vietnam veterans to the COIs limits the committee’s ability to quantify risks of specific diseases in this population.

Although serum TCDD measurements in only a small portion of Vietnam-era veterans are available, the observed distributions of these most reliable measures of exposure make it clear that they cannot be used as a standard for partitioning veterans into discrete exposure groups, such as service on Vietnamese soil, service in the Blue Water Navy, and service elsewhere in Southeast Asia. For example, many TCDD values observed in the comparison group from the AFHS exceeded US background concentrations and overlapped considerably with those of the Ranch Hand subjects.

As explained in Chapter 1, the committee for Update 2006 decided to make a general statement about its continuing inability to address that aspect of its charge quantitatively rather than to reiterate a disclaimer in the concluding section for every health outcome, and the present committee has retained that approach. p. 35
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US Navy riverine units are known to have used herbicides while patrolling inland waterways (IOM, 1994; Zumwalt, 1993), and it is generally acknowledged that estuarine waters became contaminated with herbicides and dioxin as a result of shoreline spraying and runoff from spraying on land, particularly in heavily sprayed areas that experienced frequent flooding. Thus, military personnel who did not serve on land could have been among those exposed to the chemicals during the Vietnam conflict. In recent years, there has been concern about dioxin exposure among personnel who served offshore but within the territorial limits of the Republic of Vietnam. It has been hypothesized that in addition to possibly experiencing drift from herbicide spray missions, personnel on these ships that converted seawater by distillation may have been exposed via drinking water. Those concerns were heightened by findings from an Australian study (Muller et al., 2002) that showed that TCDD could be enriched in a simulation of the potable-water distillation process that was used on the US Navy and Royal Australian Navy ships during the Vietnam War era. The National Academies convened the Blue Water Navy Vietnam Veterans and Agent Orange Exposure Committee to address that specific issue; its report (IOM, 2011) found that information to determine the extent of exposure experienced by Blue Water Navy personnel was inadequate, but that there were possible routes of exposure. P. 55
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Australian Vietnam Veterans
The Australian Vietnam Veterans study population corresponds to the cohort defined by the “Nominal Roll of Vietnam Veterans,” which lists Australians who served on land or in Vietnamese waters from May 23, 1962, to July 1, 1973, including military and some nonmilitary personnel of both sexes. People who served in all branches of service in the “defence forces” and “Citizen Military Forces” (such as diplomatic, medical, and entertainment personnel) were considered. The comprehensive studies, however, are limited to male members of the military and most of the analyses focus on men in the “defence forces”—the Army (41,084), the Navy (13,538), and the Air Force (4,570). Association of Vietnam service with cancer incidence (ADVA, 2005b) was sought by comparing diagnoses from 1982–2000 among male Vietnam veterans with those in the general population of Australia. The results in this report supersede those in the report of the Australian Department of Veterans’ Affairs (CDVA 1998a). Morbidity in all female Vietnam veterans had been studied in an earlier report (CDVA, 1998b). Additional case-control studies of the incidence of adrenal gland cancers, leukemia, and NHL were conducted in this population (AIHW, 1999, 2000, 2001). p. 139

A related report (ADVA, 2005a) considered the causes of death of men in all branches of service through 2001. The numbers of deaths were 4,045 in the Army, 1,435 in the Navy, and 686 in the Air Force. The mortality experience of military personnel serving in Vietnam was compared with that of the general population of Australia and reported by branch of service. The findings of this study supersede those in the report on mortality from 1980 to 1994 (CDVA, 1997a). There had been several earlier studies of mortality among Australian Vietnam veterans (CIH, 1984a,b,c; Crane et al., 1997a,b; Evatt, 1985; Fett et al., 1987a,b; Forcier et al., 1987). p.140

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IOM (Institute of Medicine). 2014. Veterans and Agent Orange: Update 2012.  Washington, DC: The National Academies Press.
http://www.nap.edu/catalog.php?record_id=18395 

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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