Institute of Medicine - Veterans and Agent Orange: Update 1998

David Tollerud, MD, MPH (Chair), Professor,

School of Public Health, MCP Hahnemann University

1 Member of the committee responsible for Veterans and Agent Orange (1994).

2 Member of the committee responsible for Veterans and Agent Orange: Update 1996.

Michael Aminoff, MD, Professor,

Department of Neurology, University of California at San Francisco School of Medicine

Steven Goodman, MD, MHS, PhD, Associate Professor,

Department of Oncology, Division of Biostatistics, Johns Hopkins University School of Medicine

Robert Herrick, PhD, CIH, Lecturer on Industrial Hygiene,

Department of Environmental Health, Harvard School of Public Health

Irva Hertz-Picciotto, PhD, Associate Professor,

Department of Epidemiology, University of North Carolina, Chapel Hill

David Hoel, PhD, Distinguished University Professor,

Medical University of South Carolina

Andrew Olshan, PhD, Associate Professor,

Department of Epidemiology, University of North Carolina, Chapel Hill

Trevor Orchard, MBBCh, MMSc, Professor,

University of Pittsburgh, Rangos Research Center

Howard Ozer, MD, PhD, Professor,

Department of Medicine, MCP Hahnemann University

Kenneth Ramos, PhD, Professor,

Department of Physiology and Pharmacology, Texas A&M University College of Veterinary Medicine

Noel Rose, MD, PhD, Professor,

Department of Molecular Microbiology and Immunology, Johns Hopkins University School of Hygiene and Public Health

Susan Woskie, PhD, CIH, Associate Professor,

Department of Work Environment, University of Massachusetts, Lowell

Project Staff

DAVID A. BUTLER, Study Director

SANJAY S. BALIGA, Research Associate

JAMES A. BOWERS, Research/Project Assistant

KATHLEEN R. STRATTON, Director,

Division of Health Promotion and Disease Prevention

DONNA D. DUNCAN, Division Assistant

SHARON GALLOWAY, Financial Associate

Staff Consultants

JANE DURCH, Senior Program Officer,

Institute of Medicine

CAROL MACZKA, Director of Toxicology and Risk Assessment,

National Research Council

FLORENCE POILLON, Contract Editor

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 (IOM) committee, in 1992, underscored the critical importance of approaching these questions from a non-partisan scientific 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 experiences 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 opinions, 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 backdrop 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 scientific evidence regarding the association between exposure to dioxin or other chemical compounds contained in herbicides used in Vietnam and a wide range of health effects. The report provided information 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 association exists and provided the committee's recommendations for future research.

Public Law 102-4 also tasked the NAS to conduct biennial updates that would review newly published scientific literature regarding statistical associations between health outcomes and exposure to dioxin and other chemical compounds in these herbicides. The first of these, Veterans and Agent Orange: Update 1996 (Update 1996) was published in March of that year. The focus of this second updated review is on scientific studies published since the release of Update 1996. To conduct the review, the IOM established a committee of 12 members representing a wide range of expertise to take a fresh look at the studies reviewed in VAO and Update 1996 along with the newest scientific evidence. In order to provide a link to the experience and expertise developed by the previous committees, five of the members of the committee responsible for this report were recruited from the committee responsible for Update 1996; two of these individuals also served on the VAO committee. All committee members were selected because they are leading experts in their fields, have no conflicts of interest with regard to the matter under study, and have taken no public positions concerning the potential health effects of herbicides in Vietnam veterans or related aspects of herbicide or dioxin exposure. Biographical sketches of committee members and staff appear in .