Appendix B
Information Gathering: Presentations to the Committee and Outside Meetings

COMMITTEE MEETINGS

The committee sought the fullest range of information and advice from the widest possible spectrum of sources. Given the nature of the controversy surrounding its charge, the committee deemed it vital to convene as many open meetings as possible to provide the opportunity for veterans and veterans organizations, researchers, policymakers, and other interested parties to present their concerns, review their research, and exchange information with committee members. In addition to these open meetings, the committee received special reports and the staff met with various outside experts to gather additional information for the committee.

Presentations
Committee Meeting (June 26, 1992)

At its first meeting on June 26, 1992, the committee heard presentations on background information for the study. In order to understand fully the congressionally mandated charge, the committee heard from Lawrence Hobson, Environmental Agents Service, Department of Veterans Affairs (DVA); William Brew, Senate Veterans' Affairs Committee; and Patrick Ryan, House Veterans' Affairs Committee. Following these presentations, Hellen Gelband, Office of Technology Assessment, provided some historical research background that examined the health effects of exposure to herbicides used in



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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Appendix B Information Gathering: Presentations to the Committee and Outside Meetings COMMITTEE MEETINGS The committee sought the fullest range of information and advice from the widest possible spectrum of sources. Given the nature of the controversy surrounding its charge, the committee deemed it vital to convene as many open meetings as possible to provide the opportunity for veterans and veterans organizations, researchers, policymakers, and other interested parties to present their concerns, review their research, and exchange information with committee members. In addition to these open meetings, the committee received special reports and the staff met with various outside experts to gather additional information for the committee. Presentations Committee Meeting (June 26, 1992) At its first meeting on June 26, 1992, the committee heard presentations on background information for the study. In order to understand fully the congressionally mandated charge, the committee heard from Lawrence Hobson, Environmental Agents Service, Department of Veterans Affairs (DVA); William Brew, Senate Veterans' Affairs Committee; and Patrick Ryan, House Veterans' Affairs Committee. Following these presentations, Hellen Gelband, Office of Technology Assessment, provided some historical research background that examined the health effects of exposure to herbicides used in

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Vietnam. Nancy Dalager, Environmental Epidemiology Service, DVA, summarized the DVA's research efforts on Vietnam veterans. William Farland, Office of Health and Environmental Assessment, Environmental Protection Agency (EPA), briefed the committee on the EPA's reassessment of dioxin. Upon invitation of the chairman, several other participants provided statements to the committee, including Admiral E.R. Zumwalt, Jr., Agent Orange Coordinating Council; Richard Christian, American Legion; and Laura Petrou, office of Senator Thomas Daschle. Public Meeting (September 9, 1992) The committee held a public meeting on September 9, 1992, in Washington, D.C., to solicit scientific information on the health effects of exposure to dioxin and other chemical compounds in herbicides used in Vietnam during the Vietnam era. In order to reach a broad range of interested individuals, notices of the public meeting were sent to nearly 1,000 members of veterans organizations, Congress, government agencies, academic institutions, environmental groups, chemical companies, the pulp and paper industry, medical research associations, and other groups. At the public meeting (see list), which was attended by approximately 100 people, 23 individuals presented oral testimony to the committee. Written testimony was also accepted and given equal weight to oral testimony. The committee received written testimony from 28 individuals (see summary of testimony). Scientific Workshop (December 8, 1992) The committee held a scientific workshop on exposure assessment on December 8, 1992, in Washington, D.C. The purpose of the workshop was to discuss and compare methods for estimating exposure to Agent Orange, other herbicides, and dioxin in epidemiologic studies. There were four panel sessions at the workshop to address (1) the military use of herbicides in Vietnam, (2) records-based measures of exposure to herbicides in Vietnam veterans, (3) validation of records-based measures of exposure to herbicides in Vietnam veterans, and (4) biomarkers for exposure assessment. Seventeen invited panelists made presentations at the workshop (see list). In addition to the panelists, approximately 45 individuals from veterans organizations, Congress, government agencies, academic institutions, environmental groups, chemical companies, the pulp and paper industry, medical research associations, and other interested groups attended the workshop. Committee Meeting (February 8, 1993) On February 8, 1993, the committee heard presentations on dermatological

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam disorders found in Vietnam veterans from Howard Maibach and Richard Odom, both faculty members in the Department of Dermatology, School of Medicine, University of California, San Francisco. The committee also held an open session to hear from five individuals about their personal experiences in different branches of military service in Vietnam. The committee heard presentations from Rockne Harmon, who spoke about the U.S. Navy River Patrol Force; William Lewis, who spoke about the U.S. Marine Corps; Jack Spey, who spoke about the U.S. Air Force Ranch Hand Operation; R.W. Trewyn, who spoke about the U.S. Army Infantry; and Linda S. Schwartz, who provided information on the experience of women with the U.S. military and civilian relief agencies in Vietnam. Special Contributions The committee received four reports from different groups that required special attention and are summarized below. Report on the Vietnam Veteran Agent Orange Health Study On April 9, 1993, the committee received a report summarizing the preliminary results from a health survey conducted by the Vietnam Veteran Agent Orange Health Study (VVAOHS). A questionnaire, distributed to Vietnam veterans residing in the United States and Puerto Rico, and one veteran residing in Australia, asked about any illnesses or symptoms veterans may have suffered since their service in Vietnam. These symptoms and illnesses include psychological effects, cancer, nervous system disorders, respiratory effects, digestive and metabolic disorders, reproductive effects, skin problems, and a variety of miscellaneous symptoms including diabetes, unexplained high fevers, and lightheadedness. As of April 1993, VVAOHS had received 658 completed questionnaires from veterans or their families. Preliminary results tabulated from 250 completed questionnaires indicate that birth defects (cleft palate, bone deformities, and learning disabilities), miscarriages, psychological and nervous system disorders, and skin rashes are frequently reported. Reports on the National Vietnam Veterans Birth Defects/Learning Disabilities Registry and Data Base On April 13, 1993, the committee received reports on the National Vietnam Veterans Birth Defects/Learning Disabilities Registry and Data Base, which is a collaborative effort of the New Jersey Agent Orange Commission and the Association of Children's Birth Defects. These reports were prepared independently and present two parallel interpretations of the data.

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam This project is an effort to collect and assess data on birth defects and learning disabilities among children of Vietnam veterans, and to identify patterns of disability and clustering of these patterns within certain veterans' subgroups. The project compares children of Vietnam veterans to children of nonveterans in an attempt to assess group differences. The project utilizes an 11-page questionnaire, distributed through both agencies. Data collection and analyses are ongoing. Additional information on this project is included in Chapter 9. An Appraisal of Military Records Available for Research on the Health Effects of Herbicides Used During the Vietnam War In response to a request from the Institute of Medicine, Jeanne and Steven Stellman prepared a report on their appraisal of military records available for research on the health effects of herbicides used during the Vietnam war, which the committee received on February 4, 1993. The report addresses two major issues: part 1 describes use of military records for identifying troop movement and herbicide sprays, and part 2 reviews the use of surrogate measures of herbicide exposure. Part 1 describes the extensive military data available on the use of herbicides and the location of American troops in Vietnam during the Vietnam war. The Stellmans discuss both primary and secondary data bases, and methods for linking herbicide use and troop location data. Also included is a discussion of problems of misclassification of exposure and their implications for epidemiologic and clinical research. Part 2 discusses surrogate measures of exposure that have been used in health research studies of Vietnam veterans. The advantages and limitations of such surrogates are reviewed. The Stellmans also discuss extensively their evaluation of the Centers for Disease Control (CDC) Agent Orange Validation Study, the use of serum TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin) as an exposure marker, selection process for the validation study, military records data, and data analysis. The Stellmans note that the CDC study has served as the basis for the abandonment of government epidemiologic investigations that utilize the military records data base. The Stellmans explore both the credibility of the hypothesis and the results obtained in the study. Response to the Concerns Raised in the Stellmans' February 1993 Report In response to a request from the Institute of Medicine (IOM), the Centers for Disease Control, on April 14, 1993, reviewed the February 1993 Stellmans' report to the IOM on an appraisal of military records available for research on the health effects of herbicides used during the Vietnam war.

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam CDC's report is organized into five major areas that correspond to issues raised in the Stellmans' report. The scientific basis for using serum TCDD to assess exposure to dioxin in Vietnam veterans: CDC notes that epidemiologic studies of human exposure to dioxin conducted since the Agent Orange Validation Study (the Ranch Hand Study and the NIOSH Workers Study) have provided additional support for the use of serum TCDD levels obtained in 1987 to assess previous TCDD exposure in Vietnam veterans. Military records data: CDC discusses the Agent Orange Working Group Science Panel's Subpanel on Exposure Assessment's review of the pertinent information on exposure assessment and examination of the additional pilot data that were being developed by the DOD Environmental Services Group. The subpanel recommended "that any study of ground troops, which is dependent upon military records for the assessment of exposure to herbicides, not be conducted without an additional method to verify exposure." Selection procedures for the Validation Study: CDC provides information on the selection procedures for the Agent Orange Validation Study, emphasizing how the sampling of veterans purposefully included over-sampling of veterans with high likelihood of exposure. Data analysis issues: CDC describes the analyses of 1987 TCDD measurements and exposure scores. The purpose of this analysis is to determine whether any of the scores (or some combination of scores) could predict which Vietnam veterans had elevated 1987 TCDD levels, indicating probable exposure to Agent Orange. Results and review of CDC's Validation Study: CDC notes that the Agent Orange Validation Study found no significant association between military records-based indirect estimates of Agent Orange exposure and serum TCDD levels. Outside Meetings In addition to its formal meetings, the committee actively sought information from, and explained its mission to, an array of individuals and organizations with interest or expertise in assessing the effects of exposure to herbicides used in Vietnam. Institute of Medicine staff briefed several groups on the study, met with experts, and attended conferences to gather additional information for the committee. Briefings IOM staff presented an overview of the history of the National Academy of Sciences and the IOM, the committee process, plans for the study,

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam and the institutional report review process to the Agent Orange Coordinating Council on April 14, 1992; the Senate Veterans' Affairs Committee staff and other interested congressional staff members on April 23 and May 15, 1992; and the Vietnam Veterans of America's Agent Orange Committee on November 12, 1992. Outside Experts IOM staff met with outside experts with interest or expertise in issues dealing with the effects of exposure to herbicides used in Vietnam, including Lawrence Hobson, Layne Drash, Frederic Conway, Hang Kang, Quentin Kinderman, and Donald England, Department of Veterans Affairs; William Brew and Michael Cogan, Senate Committee on Veterans' Affairs; John Brizzi and Sue Forrest, House Committee on Veterans' Affairs; Michael Gough and Hellen Gelband, Office of Technology Assessment; Peter Beach, Department of Health and Human Services; Alvin Young, Department of Agriculture; Don Hackenson, Environmental Services Group, Department of Defense; Theodore Colton, Boston University; James Neel, University of Michigan Medical School; Richard Christian, American Legion; Richard Thomas, National Research Council (NRC); and Shelby Stanton, consultant. Seminars and Conferences Committee and staff members attended several seminars and conferences to gather additional material for the study. These included the Brookings Institution Risk Seminars on Dioxin held in Washington, D.C.; the Environmental Protection Agency's Dioxin Peer Review Workshop: Health Assessment Document held in Vienna, Virginia; the 1992 American Public Health Association sessions Reassessing Dioxin's Health Effects and The Enduring Health Effects in Southeast Asia held in Washington, D.C.; a jointly sponsored meeting by the Toxicology Forum and German government, Current Views on the Impact of Dioxins and Furans on Human Health and the Environment, held in Berlin, Germany; a conference on Male-Mediated Developmental Toxicity held in Pittsburgh; and the seminar Human Tissue Monitoring and Specimen Banking: Opportunities for Exposure Assessment, Risk Assessment, and Epidemiologic Research held in Research Triangle Park, North Carolina. Commissioned Papers To address all the issues that the committee was required to review, several outside experts were asked to prepare background papers on

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Toxicologic Data for Cacodylic Acid Toxicologic Data for Picloram Judith Hauswirth and Barbara Neal, Jellinek, Schwartz & Connolly, Inc. Toxicity Profile of 2,4-D Toxicity Profile of 2,4,5-T Gail Charnley, National Research Council TCDD's Carcinogenicity in Animals Gail Charnley, National Research Council TCDD Reproductive Toxicity Gail Charnley, National Research Council Neurotoxicological Aspects of Dioxin John O'Donoghue, Eastman Kodak Company Environmental Presence and Persistence of Dioxins Christopher Uchrin, Rutgers University Exposure to Herbicides and Dioxin and Porphyria Cutanea Tarda (PCT) Neville Pimstone, University of California at Davis Possible Effects of 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) on Autoimmune Disease of Humans Noel R. Rose, Johns Hopkins University Evaluation of the Frequency of Birth Defects Among the Offspring of Vietnam Veterans Lewis Holmes, Massachusetts General Hospital PRESENTATIONS AT THE PUBLIC MEETING September 9, 1992 Session I E.R. Zumwalt, Admiral, U.S. Navy (Ret.) Ellen K. Silbergeld, University of Maryland at Baltimore William W. Lewis, New Jersey Agent Orange Commission, Trenton Betty Mekdeci, Association of Birth Defect Children, Orlando, Florida Gerald Bender, Agent Orange Program, State of Minnesota Department of Veterans Affairs, St. Paul Session II Cate Jenkins, Environmental Protection Agency, Washington, D.C. Turner Camp, Veterans of Foreign Wars, Washington, D.C. Michael Harbut, Center for Occupational and Environmental Medicine, Southfield, Michigan Steven Stellman, American Health Foundation, New York City Jeanne Stellman, Columbia University School of Public Health, New York City (presented by Steven Stellman)

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Session III Steven J. Milloy, Institute for Regulatory Policy, Washington, D.C. Rockne Harmon, Alameda, California, and James Harmon, Garden City, New York, Attorneys/Vietnam Veterans Michael N. Sovick, Oklahoma Agent Orange Foundation, Lexington James H. Burdge, Sr., Vietnam Veteran/Agent Orange Health Study, Eatontown, New Jersey Hope Tinoco, Wife of Vietnam Veteran, Olathe, Kansas Don Braksick, Vietnam Veteran, Leesburg, Florida Session IV Harold Jackson, Vietnam Veteran, Houston, Texas Julio Gonzales, Vietnam Veteran, Chicago, Illinois Michael Eckstein, Vietnam Veterans of America, Eatontown, New Jersey Paulette Boland, Widow of Vietnam Veteran, Chicago, Illinois Mike Guess, Vietnam Veteran, Jerseyville, Illinois Jennie LeFevre, Widow of Vietnam Veteran, Shady Side, Maryland Open Session Steven Lamm, Consultants in Epidemiology and Occupational Health, Washington, D.C. Chester McKee, Military Order of the Purple Heart, Washington, D.C. SCIENTIFIC WORKSHOP ON EXPOSURE ASSESSMENT December 8, 1992 Session 1: The Military Use of Herbicides in Vietnam Alvin Young, Department of Agriculture Fred H. Tschirley, Consultant Session 2: Records-Based Measures of Exposure to Herbicides in Vietnam Veterans Han Kang, Department of Veterans Affairs Richard Clapp, JSI Research and Training, Inc. Steven Stellman, American Health Foundation Jeanne Stellman, School of Public Health, Columbia University Richard Christian, The American Legion Session 3: Validation of Records-Based Measures of Exposure to Herbicides in Vietnam Veterans Edward Brann, Epidemiology Program Office Dana Flanders, National Center for Environmental Health

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam John Karon, National Center for Infectious Diseases Mark Scally, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Session 4: Biomarkers for Exposure Assessment Joel Michalek and Judson Miner, U.S. Air Force School of Aerospace Medicine William Lewis, New Jersey Agent Orange Commission Marilyn Fingerhut, National Center for Occupational Safety and Health, Centers for Disease Control and Prevention James Pirkle, Center for Environmental Health, Centers for Disease Control and Prevention Arnold Schecter, State University of New York TESTIMONY PRESENTED TO THE COMMITTEE (ORAL AND WRITTEN) Political and Controversial Issues Gerald Bender, Minnesota Department of Veterans Affairs, St. Paul Topic: The IOM committee is a scientific entity—not a policymaking one—and must be allowed to make recommendations based solely on established methods of scientific investigation; since certainty can rarely be achieved on scientific issues, the committee might be unable to provide the definite answers on causation desired by the public. William Bennett, National Vietnam Veterans Coalition, Washington, D.C. Topic: Directs the committee's attention to various extra scientific material, which sheds light on the conduct of certain studies and other information about the political controversy over Agent Orange. Don Braksick, Vietnam Veteran, Leesburg, Florida Topic: Personal account of government conspiracy to cover-up the long-term health effects of Vietnam veterans' exposure to Agent Orange. Turner Camp, Medical Consultant, Veterans of Foreign Wars, Washington, D.C. Topic: The history of the Veterans of Foreign Wars involvement in the Agent Orange controversy on behalf of its members. Also a recapitulation of resolutions pertaining to Agent Orange forwarded by its membership for action at the national level.

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Joy Towles Cummings, HOPE (Help Our Polluted Environment), Salem, Florida Topic: Personal account of a cellulose chlorine-using pulp mill, which has been polluting the Fenholloway River in Florida with dioxin for the past 38 years. The fish in the river are contaminated, as is groundwater in the area. The community claims that there is a high cancer risk in the area and many of the children have learning disabilities. The community would like to have an investigation of the health risks of residents living near or downstream of chlorine-using pulp and paper mills. Michael Eckstein, Vietnam Veterans of America, Eatontown, New Jersey Topic: The New Jersey State Council's Agent Orange Committee would like the IOM committee to review scientific evidence uncovered by the Environmental Protection Agency, the Pointman projects, the Agent Orange Coordinating Council, and the records of defunct state Agent Orange Commissions. Also noted that the committee should seek the records of Dow Chemical, Diamond Shamrock, and other producers of herbicides used in Vietnam. Chester McKee, Military Order of the Purple Heart, Washington, D.C. Topic: Requested, on behalf of the Military Order of the Purple Heart, that the committee take into account, during its deliberations, the plight of the veterans who claim to have been exposed to Agent Orange while serving in the military in Vietnam. Lawrence Welch, Vietnam Veteran, Havelock, North Carolina Topic: Reasons for believing that Public Law 102-4 and the Department of Veterans Affairs are in error for excluding chondrosarcoma from recognition as a soft tissue sarcoma associated with exposure to certain herbicides used in Vietnam and, therefore, from compensation. E.R. Zumwalt, Admiral, U.S. Navy (Ret.), Arlington, Virginia Topic: The manner in which policy decisions sometimes impact on science to produce flawed scientific results. Also provided the committee with 12 documents for its review including his report to Edward J. Derwinski (former Secretary of Veterans Affairs), court documents, congressional hearings, and federal government memoranda.

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Concerns About the NRC Process Richard Christian, The American Legion, Washington, D.C. Topic: The American Legion's concerns about how the IOM study should be conducted openly and without conflicts of interest. Cate Jenkins, Ph.D., Environmental Protection Agency, Washington, D.C. Topic: Jenkins's 1991 affidavit prepared on behalf of veterans attempting to gain compensation from the manufacturers of Agent Orange, and additional data compiled to support the causal relationship between dioxin and lasting central nervous system effects. Another issue raised was potential and apparent conflicts of interest in selecting individuals to serve on the review committee. Scientific Issues Richard Albanese, M.D., U.S. Air Force School of Aerospace Medicine, San Antonio, Texas Topic: Personal opinion that most herbicide studies have sample sizes that are too small to detect an herbicide effect when such an effect exists and, because of this fact and inadequate treatment of type II error, Vietnam veterans' concerns about herbicides do not receive a fair hearing and judgment. Malcolm Barr, Toxicologist, Victoria, Australia Topic: Personal research that has uncovered new evidence implicating certain environmental agents as potential causes of PostTraumatic Stress Disorder in vulnerable individuals with deficient detoxification mechanisms and indicating that certain phenolic herbicides used in Agent Orange could be implicated in Vietnam veterans' psychiatric disorders. He has developed a clinical toxicological model to treat veterans. Noel Benefield, Waiuku, New Zealand Topic: Personal submission on the association between exposure of rodents to certain chemical compounds and birth defects. James H. Burdge, Sr., Founder, Vietnam Veteran/Agent Orange Health Study, New Jersey Topic: The Vietnam Veteran Agent Orange Health Study, in which questionnaires are sent to veterans and data are compiled from returned questionnaires. He also encouraged the committee to be open to the veterans and their families, and listen to what they have to say about this issue.

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Joe Cole, BRAVO/International Independent Agent Orange Network, Olympia, Washington Topic: Chemicals used in Vietnam during the Vietnam era and a list of health effects thought to be associated with exposure to Agent Orange, along with toxicity data on several other chemicals. Campbell Colton, Veterans Counselor, Division of Veterans Services, Augusta, Maine Topic: The Report on the Health and Medical Status of Maine Veterans, May 13, 1991, and a Medical Survey on Radiation and Agent Orange Veterans of Maine, August 1990. Robert Donnan, Vietnam Veteran, McMurray, Pennsylvania Topic: Health effects on the Vietnamese population of exposure to Agent Orange need to be evaluated, along with a review of the literature regarding the health effects of exposure to 2,4-D. Dale Duke, Vietnam Veteran, Albuquerque, New Mexico Topic: Personal research on the epidemiology of multiple myeloma, along with a review of the literature. Also a personal account of his diagnosis of multiple myeloma and his claim to the Department of Veterans Affairs. Michael Harbut, M.D., M.P.H., Physician-in-Chief, Center for Occupational and Environmental Medicine, Southfield, Michigan Topic: Described clinical treatment of three patients (Vietnam veterans), primarily for respiratory problems, autoimmune disorders, dermatological problems, neuromuscular problems, sexual dysfunction, psychological dysfunction, and blood dyscrasia; personal opinion is that a disease syndrome exists as a result of exposure to Agent Orange. James Kasanos, Vietnam Veteran, Otter Rock, Oregon Topic: List of toxins used in Vietnam and a summary of reported Agent Orange symptoms and effects. Steven Lamm, M.D., Epidemiology and Occupational Health Consultants, Washington, D.C. Topic: Personal observation of various interpretations of the dioxin literature, as well as how the committee should take care to distinguish the differences in exposures (categorically and qualitatively) among various studies.

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam William W. Lewis, New Jersey Agent Orange Commission, Trenton Topic: The research efforts of the New Jersey Agent Orange Commission, particularly the Pointman Project. Pointman I was a pilot project designed to determine whether dioxin levels could be found in Vietnam veterans who had handled herbicides. Pointman II examined exposure levels of Vietnam veterans who were not herbicide handlers. Betty Mekdeci, Executive Director, Association of Birth Defect Children, Orlando, Florida Topic: The Association of Birth Defect Children has been selected by the State of New Jersey to collect information for the New Jersey Agent Orange Commission on birth defects, learning disabilities, childhood cancers, and other health problems in the children of Vietnam veterans. Steven J. Milloy, Institute for Regulatory Policy, Washington, D.C. Topic: The interpretation of low statistical associations in the context of a ''weight-of-evidence" approach to causal inference. Given the existing epidemiological studies on dioxin-like compounds, this is a linchpin in the committee's review. Arnold Schecter, M.D., M.P.H., State University of New York Topic: Research on Vietnam concerning Agent Orange and dioxin exposure, and possible health effects on Vietnamese (the population most heavily exposed) and on American veterans, from his work coordinating the Michigan and the Massachusetts Agent Orange studies. Ellen K. Silbergeld, Ph.D., University of Maryland at Baltimore Topic: The current scientific evidence for the plausibility of biological mechanisms involved in the association of herbicide exposure with certain health effects in humans. Her research shows that there is no basis in molecular biology to postulate or invent putative thresholds in the mechanistic biology and toxicology of dioxin. Michael N. Sovick, Oklahoma Agent Orange Foundation, Lexington, Oklahoma Topic: Lists of scientific references as evidence of the association between autoimmune and other immunological disorders (e.g., lupus erythematosus) and exposure to dioxin.

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Jeanne Stellman, Ph.D., Columbia University School of Public Health, New York City Topic: Herbicide exposure assessment and available military information, and the relationship to the HERBS tape and available exposure methodologies. The Stellmans' principal concern with the primary literature is how individual authors estimate exposure and how they relate their findings specifically to Agent Orange. Another concern is with studies utilizing surrogate measures because surrogates as used invariably assign far more men to an exposed status than were really exposed, and thereby dilute the truly exposed population. Steven Stellman, Ph.D., M.P.H., American Health Foundation, New York City Topic: Analysis of the available health data including the Stellmans' (see Jeanne Stellman) work. The Stellmans are co-authors of the Columbia University-American Legion Study of Vietnam Veterans, and were the exposure consultants to the Agent Orange Veteran Payment Program for the U.S. Federal Court for the Eastern District of New York. It was noted that the Centers for Disease Control's methodology for matching troop and spray locations was almost identical to the Stellmans and that it has never been clear why CDC canceled its study estimating exposure based on troop locations and, instead, began a validation study to identify dioxin levels in serum of selected Vietnam veterans. Syntex Agribusiness, Inc., Springfield, Missouri Topic: Comments on human exposure to dioxin and dioxin-like compounds. This is a key component in making a determination as to whether any adverse health effects in Vietnam ground troops are associated with dioxin and other chemical compounds in herbicides used in Vietnam. It is critical to establish the extent of exposure of Vietnam ground troops relative to each of the other human population groups that has been exposed to dioxin and dioxin-like compounds. To facilitate a determination of whether a particular adverse health effect is associated with dioxin exposure, one should examine whether that effect follows a dose-response relationship. Jerome Torczyner, Foster City, California Topic: Personal research on the possibility that "superantigens" in humans may be the cause of lymphomas and cancers experienced by Vietnam veterans.

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Individual Reports of Possible Health Effects Due to Exposure Roman Besaha, Vietnam Veteran, St. Petersburg, Florida Topic: Personal account of health effects, thought to be due to exposure to Agent Orange, include chloracne, fatigue, stomach pains, psychological disorders, and a malignant tumor in right thigh. Also, his personal research on injured adrenal glands, which may cause psychological problems. Paulette Boland, Widow of Vietnam Veteran, Chicago, Illinois Topic: Personal account of late husband's death, which is thought to be due to exposure to Agent Orange. Her husband served in the "Iron Triangle," which was heavily defoliated with Agent Orange. After returning home, he developed a thalamic hemorrhage and later died from a large left thalamic tumor. Her son, who was born after her husband returned from Vietnam, died at age 10 from a rare malignant tumor of the thalamus. John Corwin, Vietnam Veteran, Chillicothe, Ohio Topic: Personal account of psychosocial disorders, which are thought to be due to exposure to Agent Orange. William W. Dean, Vietnam Veteran, Apple Valley, Minnesota Topic: Personal account of having multiple bilateral fibromatosis (MBF) tumors and his research on the biological plausibility of exposure to dioxin and the development of MBF tumors of the hands and feet (bilateral palmar Dupuytren's contractures, bilateral plantar Dupuytren's contractures). Julio Gonzales, Vietnam Veteran, Chicago, Illinois Topic: List of 59 chemicals that were used in Vietnam during the war for the committee to consider in its review, along with background material on each of these chemicals and a paper on the health effects of these chemicals. Also, a personal account of his diagnoses of bladder cancer, chloracne, and peripheral neuropathy, which are thought to be due to exposure to Agent Orange. Mike Guess, Vietnam Veteran, Jerseyville, Illinois Topic: Personal account of being diagnosed at age 39 as having multiple myeloma, which is thought to be due to his exposure to Agent Orange. He served in the Marine Corps, and was sent to serve with the 26th Marines at Que Son, in I Corps. The troops

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam   drank the local water and ate whatever they could find. They were aware that a defoliant was being sprayed in the area, only they did not know it was Agent Orange; the spray landed on their water source as well as all of their food and belongings. Rockne Harmon, California, and James Harmon, New York, Attorneys/Vietnam Veterans Topic: Personal account of Rockne and James Harmon, brothers who are both Vietnam veterans. James was a platoon leader in the First Cavalry Division and served in areas heavily exposed to Agent Orange or other herbicides. He had a child who died from malignant fibrous histiocytoma. Rockne was assigned to the Navy Swift Boat squadron and served in the inland waterways of the Mekong Delta and Cambodia in areas heavily defoliated by Agent Orange or other herbicides. He has a child that has been diagnosed with retinoblastoma, which resulted in loss of an eye and serious developmental delays. Harold Jackson, Vietnam Veteran, Houston, Texas Topic: Personal account of his diagnosis of chronic relapsing autoimmune polyneuropathy with peripheral neuropathy, which is thought to be due to exposure to Agent Orange. He is now disabled and uses a wheelchair. He has an identical twin brother who did not serve in the military and is in perfect health. Henry Kinsey, Vietnam Era Veteran, Rathdrum, Idaho Topic: Personal account of the health effects of 10 veterans stationed at Camp Alpine in Fuji, Japan, thought to be due to exposure to Agent Orange. These veterans mixed chemicals from 55 gallon green drums with orange bands around them and dipped timbers into the mixture to preserve them. Jennie LeFevre, Widow of Vietnam Veteran, Shady Side, Maryland Topic: Personal account of late husband's health problems and eventual death from cancer of the liver, stomach, spleen, pancreas, lungs, lymph nodes, and soft tissue sarcoma, thought to be due to exposure to Agent Orange. John Martignette, Vietnam Veteran, Bethlehem, New Hampshire Topic: Personal account of his health problems, which are thought to be due to exposure to Agent Orange.

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Terry Miller, Vietnam Veteran, Mendota, Illinois Topic: Personal account of health effects—includes metabolic disorders, psychosocial disorders, chloracne and other skin disorders, and respiratory disorders—of Terry Miller and his family, which are thought to be due to his exposure to Agent Orange. Verna Mullinax, Widow of Vietnam Veteran, Goldsboro, North Carolina Topic: Personal account of her late husband's death, which is thought to be due to exposure to Agent Orange. John Mullinax served in the Ranch Hand unit of the U.S. Air Force as a flight engineer. He was responsible for loading herbicide on the aircraft and discharging it during spray operations. Gary Porter, Vietnam Veteran, Indianapolis, Indiana Topic: Personal account of being diagnosed with squamous cell carcinoma. He served with D Company, 151st Airborne Rangers at Bien Hoa, South Vietnam, 1968-1969. Notes that he was not asked about his military service in Vietnam while being examined for his cancer. Shannon Puglia, Widow of Vietnam Veteran, Dingmans Ferry, Pennsylvania Topic: Personal account of her late husband's exposure to Agent Orange. He served in III Corps, Bien Hoa Province, east of Cu Chi—in the Iron Triangle, which was one of the areas most heavily sprayed with herbicides. Patricia Robinson, Widow of Vietnam Veteran, San Diego, California Topic: Personal account of her late husband's death and son's delayed development stemming from neurological problems, which are thought to be due to her husband's exposure to Agent Orange. Doris and Fred Scobey, Parents of Vietnam Veteran, Hollywood, California Topic: Personal account of their son's death from cancer, which is thought to be due to exposure to Agent Orange. Their son served aboard an aircraft carrier, where he was part of the launch crew. Apparently, there were Agent Orange canisters attached to the bellies of the planes, and he was exposed to Agent Orange while working with the planes. Carol Solbey, Widow of Vietnam Veteran, East Grand Forks, Minnesota Topic: Personal account of her late husband's death from chondrosarcoma, which is thought to be due to his exposure to Agent Orange. Her son was born with birth defects and a primary immune deficiency, thought to be due to her husband's exposure to Agent Orange.

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Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Hope Tinoco, Wife of Vietnam Veteran, Olathe, Kansas Topic: Personal account of her husband's health problems, which are thought to be due to exposure to Agent Orange. During his tour of duty in Vietnam, John Tinoco documented that he was in many locations that had been sprayed with Agent Orange. The health problems that he has experienced since then include chloracne and other skin disorders. Shelia Winsett, Friend of Vietnam Veteran, Jasper, Alabama Topic: Personal account of friend's health problems, which are thought to be due to exposure to Agent Orange.