Veterans and Agent Orange Update 2002 Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Fourth Biennial Update) Board on Health Promotion and Disease Prevention THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, NW • Washington, D.C. 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Insti- tute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The project was supported by Contract No. V101(93)P-1637 between the National Academy of Sciences and the US Department of Veterans Affairs. 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Wulf are chair and vice chair, respectively, of the National Research Council www.national-academies.org COMMITTEE TO REVIEW THE HEALTH EFFECTS IN VIETNAM VETERANS OF EXPOSURE TO HERBICIDES (FOURTH BIENNIAL UPDATE) Irva Hertz-Picciotto, (Chair), Professor, Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina Kiros T. Berhane, Assistant Professor, Department of Preventive Medicine, University of Southern California, Los Angeles, California Margit L. Bleecker, Director, Center for Occupational and Environmental Neurology, Baltimore, Maryland Paul F. Engstrom, Senior Vice President and Medical Director, Fox Chase Network, Philadelphia, Pennsylvania Richard A. Fenske, Professor, Environmental Health, Industrial Hygiene and Safety Program, University of Washington, Seattle, Washington Thomas A. Gasiewicz, Professor of Environmental Medicine and Deputy Director of the Environmental Health Sciences Center, University of Rochester, Rochester, New York Tee L. Guidotti, Professor and Chair of the Department of Environmental and Occupational Health, The George Washington University School of Public Health and Health Services, Washington, DC Loren D. Koller, Consultant, Environmental Health and Toxicology, Corvallis, Oregon John J. Stegeman, Senior Scientist and Chair of the Biology Department, Woods Hole Oceanographic Institution, Woods Hole, Massachusetts David S. Strogatz, Associate Professor and Chair of Epidemiology, School of Public Health, State University of New York at Albany, New York Staff Michelle C. Catlin, Study Director Jennifer A. Cohen, Research Associate Anna B. Staton, Research Assistant Elizabeth J. Albrigo, Project Assistant Joe A. Esparza, Project Assistant Jakki Sears, Project Assistant (Temporary Staff) Norman Grossblatt, Senior Editor David A. Butler, Senior Program Officer Rose Marie Martinez, Director, Board on Health Promotion and Disease Prevention Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures ap- proved by the NRC’s Report Review Committee. The purpose of this indepen- dent review is to provide candid and critical comments that will assist the institu- tion in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confiden- tial to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Linda S. Birnbaum, U.S. Environmental Protection Agency Chris Gennings, Virginia Commonwealth University Russ B. Hauser, Harvard School of Public Health Robert H. Herrick, Harvard School of Public Health Howard M. Kipen, University of Medicine and Dentistry of New Jersey— Robert Wood Johnson Medical School Henry C. Pitot, McArdle Cancer Research Stephen H. Safe, Texas A&M University Joseph V. Simone, Simone Consulting Bailus Walker, Jr., Howard University Cancer Center Although the reviewers listed above have provided many constructive com- ments and suggestions, they were not asked to endorse the conclusions or recom- mendations nor did they see the final draft of the report before its release. The vii viii REVIEWERS review of this report was overseen by Robert B. Wallace, University of Iowa. Appointed by the National Research Council and Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. Preface In response to the concerns voiced by Vietnam veterans and their families, Congress called upon the National Academy of Sciences (NAS) to review the scientific evidence on the possible health effects of exposure to Agent Orange and other herbicides (Public Law 102-4, enacted on February 6, 1991). The creation of the first NAS Institute of Medicine committee, in 1992, underscored the critical importance of approaching these questions from a non-partisan scien- tific standpoint. The original Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides realized from the beginning that it could not conduct a credible scientific review without a full understanding of the experi- ences and perspectives of veterans. Thus, to supplement its standard scientific process, the committee opened several of its meetings to the public in order to allow veterans and other interested individuals to voice their concerns and opin- ions, to provide personal information about individual exposure to herbicides and associated health effects, and to educate committee members on recent research results and studies still under way. This information provided a meaningful back- drop for the numerous scientific articles that the committee considered. Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (abbreviated as VAO in this report) reviewed and evaluated the available scien- tific evidence regarding the association between exposure to 2,3,7,8-tetrachloro- dibenzo-p-dioxin (TCDD) or other chemical compounds contained in herbicides used in Vietnam and a wide range of health effects. The report provided informa- tion for the secretary of veterans affairs to consider as the Department of Veterans Affairs carried out its responsibilities to Vietnam veterans. It also described areas in which the available scientific data were insufficient to determine whether an ix