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Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
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GULF WAR and HEALTH

VOLUME 2

Insecticides and Solvents

Committee on Gulf War and Health: Literature Review of Pesticides and Solvents

Board on Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
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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 Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

Support for this project was provided by the Department of Veterans Affairs. The views presented in this report are those of the Institute of Medicine Committee on Gulf War and Health: A Literature Review of Pesticides and Solvents and are not necessarily those of the funding agency.

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Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
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“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

Shaping the Future for Health

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
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THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M.Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm.A.Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M.Alberts and Dr. Wm.A.Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
×

COMMITTEE ON GULF WAR AND HEALTH: LITERATURE REVIEW OF PESTICIDES AND SOLVENTS

JACK M.COLWILL (Chair), Professor Emeritus,

School of Medicine, University of Missouri-Columbia, Columbia, Missouri

SAMUEL J.POTOLICCHIO (Vice-Chair), Professor,

Department of Neurology, George Washington University Medical Center, Washington, DC

ANN ASCHENGRAU, Professor,

Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts

LORNE A.BECKER, Chairman,

Department of Family Medicine, State University of New York Upstate Medical University, Syracuse, New York

DEBORAH A.CORY-SLECHTA, Professor and Chair,

Department of Environmental Medicine, University of Rochester, Rochester, New York

WILLIAM E.DANIELL, Associate Professor,

Department of Environmental Health, School of Public Health and Community Medicine, University of Washington, Seattle, Washington

MARION F.EHRICH, Professor,

Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia

MANNING FEINLEIB, Professor of Epidemiology,

Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland

ROBERT G.FELDMAN, Professor of Neurology,

Boston University School of Medicine, Boston, Massachusetts

MARK S.GOLDBERG, Associate Professor,

Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada

LYNN R.GOLDMAN, Professor,

Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland

ROSE H.GOLDMAN, Associate Professor of Medicine,

Harvard Medical School,

Associate Professor,

Department of Environmental Health, Harvard School of Public Health, Cambridge, Massachusetts

RONALD GOLDNER, Clinical Professor of Dermatology,

University of Maryland School of Medicine, Baltimore, Maryland

DAVID F.GOLDSMITH, Associate Research Professor,

George Washington University, Washington, DC

CYNTHIA HARRIS, Director and Associate Professor,

College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, Florida

RUSS B.HAUSER, Assistant Professor,

Occupational Health Program, Harvard School of Public Health, Boston, Massachusetts

JANICE L.KIRSCH, Study Oncologist and Researcher,

Northern California Childhood Leukemia Project, University of California, Berkeley, California

ANTHONY L.KOMAROFF, Professor of Medicine,

Harvard Medical School, Cambridge, Massachusetts

MICHAEL L.LEFEVRE, Director of Clinical Services,

Department of Family and Community Medicine, School of Medicine, University of Missouri-Columbia, Columbia, Missouri

RICHARD MAYEUX, Gertrude H.Sergievsky Professor of Neurology,

Psychiatry and Public Health, Columbia University, New York, NY

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
×

STEPHEN A.MCCURDY, Associate Professor of Medicine,

University of California, Davis, California

SANDRA MOHR, Formerly with the National Jewish Medical and Research Center,

Division of Environmental and Occupational Health Sciences, Denver, Colorado

TOSHIO NARAHASHI, John Evans Professor of Pharmacology, Alfred Newton Richards Professor of Pharmacology,

Northwestern University, Chicago, Illinois

LEENA A.NYLANDER-FRENCH, Assistant Professor,

Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, North Carolina

MICHAEL O’MALLEY, Staff Physician,

Employee Health Service, University of California, Davis, California

CHARLES POOLE, Associate Professor,

Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina

CARRIE A.REDLICH, Associate Professor,

Department of Medicine, Occupational and Environmental Medicine Program, Yale University School of Medicine, New Haven, Connecticut

JOSEPH V.RODRICKS, Principal,

Environ, Inc., Arlington, Virginia

KENNETH D.ROSENMAN, Professor,

Department of Medicine, Michigan State University, East Lansing, Michigan

MARY ANN SMITH, Assistant Professor,

School of Public Health, University of Texas-Houston Health Sciences Center, Houston, Texas

ANNE M.SWEENEY, Associate Professor,

School of Rural Public Health, Texas A&M University, Bryan, Texas

PATRICK R.M.THOMAS, Radiation Oncologist,

Bardmoor Cancer Center, Largo, Florida

WILLIAM M.VALENTINE, Associate Professor,

Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee

JOHN E.VENA, Professor,

Department of Social and Preventive Medicine,

Director,

Environmental and Society Institute, University of Buffalo, Buffalo, New York

LAURA STEWART WELCH, Director,

Occupational and Environmental Medicine, Washington Hospital Center, Washington, DC

CHRISTINA WOLFSON, Associate Professor,

Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada

TONGZHANG ZHENG, Associate Professor,

Division of Environmental Health Sciences, Yale University School of Public Health, New Haven, Connecticut

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
×

STAFF

CAROLYN E.FULCO, Senior Program Officer

CATHARYN T.LIVERMAN, Senior Program Officer

CARRIE I.SZLYK, Program Officer

MICHELLE CATLIN, Senior Program Officer

SANDRA AU, Research Associate (until May 2002)

SUSAN FOURT, Research Associate (until May 2002)

MICHAEL SCHNEIDER, Research Associate

JUDITH A.URBANCZYK, Research Associate

HOPE R.HARE, Research Assistant

A.WEZI MUNTHALI, Research Assistant

KAREN AUTREY, Senior Project Assistant (until February 2002)

JUDITH ESTEP, Senior Project Assistant (until December 2002)

ROSE MARIE MARTINEZ, Director,

Board on Health Promotion and Disease Prevention

CONSULTANTS

APPLIED EPIDEMIOLOGY, INC.,

Amherst, Massachusetts

MIRIAM DAVIS, Independent Medical Writer,

Silver Spring, Maryland

DIANE MUNDT,

Applied Epidemiology, Inc., Amherst, Massachusetts

MARY PAXTON, Independent Consultant,

Falls Church, Virginia

ELIZABETH TONKIN,

Vanderbilt University Medical Center

MARIE-FRANCE VALOIS,

McGill University, Montreal, Canada

LISA ZIMMERMAN,

Vanderbilt University Medical Center

EDITORS

NORMAN GROSSBLATT, NRC Senior Editor

KATE KELLY, Independent Editor

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
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REVIEWERS

This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution 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 confidential to protect the integrity of the deliberative process. We wish to thank the following for their review of this report:

JAMES V.BRUCKNER, Professor, Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, University of Georgia, Athens, GA

LUCIO G.COSTA, Professor of Environmental Health, Toxicology and Department of Environmental Health, University of Washington, Seattle, WA

BERNARD D.GOLDSTEIN, Dean, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA

PHILIPPE GRANDJEAN, Adjunct Professor of Public Health, Department of Environmental Health, Boston University School of Public Health, Boston, MA

MATTHEW C.KEIFER, Director, Occupational and Environmental Medicine Program, Harborview Medical Center, University of Washington, Seattle, WA

ANDREW F.OLSHAN, Professor, Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC

DAVID OZONOFF, Chair, Department of Environmental Health, Boston University School of Public Health, Boston, MA

THOMAS G.ROBINS, Professor, Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI

PALMER W.TAYLOR, Sandra and Monroe Trout Chair and Professor, Department of Pharmacology, School of Medicine, University of California, San Diego, La Jolla, CA

DAVID J.TOLLERUD, Center for Environmental and Occupational Health, Hahnemann University, Philadelphia, PA

CURTIS TRAVIS, Quest Technologies, Knoxville, TN

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by DONALD R.MATTISON, Senior Adviser, National Institute of Child Health and Human Development and the Center for Research for Mothers and Children, who was appointed by the Institute of Medicine and HAROLD C.SOX, Annals of Internal Medicine, American College of Physicians-American Society of Internal Medicine, who was appointed by the Report Review Committee. They were 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 author committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
×

PREFACE

More than a decade has passed since the Gulf War. After the Iraqi invasion of Kuwait on August 2, 1990, about 700,000 US military personnel were deployed to the Persian Gulf. Air attacks against Iraqi forces began on January 2, 1991, and the ground war followed between February 24 and 28. Despite the short duration and the small number of immediate casualties, allied forces were exposed to the horrors of war and to many noxious substances. After the war, large numbers of veterans suffered from a variety of symptoms characterized in part by fatigue, headache, difficulties of cognition, and vague arthralgias. Studies of military personnel clearly demonstrate that the prevalence of those symptoms has been higher in those deployed to the Persian Gulf than in those not deployed.

Veterans, Congress, the Department of Defense (DOD), and the Department of Veterans Affairs (VA) all have been deeply concerned about the etiology of the symptoms that were so prevalent among Gulf War veterans. As a result of requests by Congress, the Institute of Medicine (IOM) has embarked on a series of studies to review the health effects of many of the biologic, chemical, and environmental agents to which veterans may have been exposed. Our committee was charged in the second study to review the literature on the long-term human health effects of insecticides and solvents thought to have been used in the Gulf War.

Because of the large volume of literature on those compounds, IOM appointed a 37-member committee, one of the largest committees in its history. Our committee is composed of epidemiologists, toxicologists, industrial hygienists, and physicians with expertise in a number of relevant fields, including occupational medicine, neurology, dermatology, oncology, family medicine, and internal medicine.

The task of this committee was to identify for review the literature that focused on the insecticides and solvents to which Gulf War veterans may have been exposed. DOD, VA, RAND researchers, and Gulf War veterans provided information about the agents used.

The committee addressed the full scope of health effects that are potentially associated with insecticides and solvents, not just the veterans’ symptoms. It focused on human studies of long-term effects that might follow exposure to those agents, inasmuch as veterans’ symptoms have continued long after the war. The primary literature reviewed was epidemiologic studies of various occupational groups; when available, studies of Gulf War veterans were included in the committee’s analysis. Experimental data and toxicologic studies provided information about the acute and long-term effects of insecticides and solvents on humans and animals and about plausible biologic mechanisms of adverse health outcomes.

The committee placed its conclusions in categories of strength of evidence. Similar categories were used in Volume 1 of Gulf War and Health and in numerous other IOM studies.

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
×

Given the varied expertise and judgment within the committee, members occasionally differed in their interpretation of findings. In some instances committee members, even after careful deliberation, could not reach consensus on the category of association for a particular conclusion. In those instances, the committee presents no conclusion but discusses both points of view in the chapter and notes where additional research might be needed to draw more definitive conclusions.

Although the committee found associations between exposure to insecticides or solvents and some diseases and symptoms in some occupational groups, it was faced with a paucity of data regarding exposure for veterans. Therefore, it could not extrapolate from findings in published studies to the likelihood that veterans’ illnesses are related to exposure to insecticides or solvents.

Despite the many challenges faced by the committee as it reviewed the epidemiologic literature, it arrived at numerous conclusions regarding associations. We hope that our review will be helpful not only for veterans but also for other groups interested in the long-term health outcomes of exposure to insecticides and solvents.

Jack M.Colwill, M.D., Chair

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
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ACKNOWLEDGMENTS

The committee wishes to express its appreciation to the many people who contributed to this study by sharing their experience and providing their expertise. A number of Gulf War veterans presented information on the use of pesticides and solvents during the Gulf War. Speakers at the committee’s May 2001 meeting included Venus Hammack, Desert Storm Battle Registry; Patrick Eddington, National Gulf War Resource Center; Kirt Love, Desert Storm Battle Registry; Denise Nichols, National Vietnam and Gulf War Veterans Coalition; Ed Bryan, Persian Gulf Era Veterans, Massachusetts; and David Johnson, University of Oklahoma Health Sciences Center. In addition, the committee appreciates the information received from many other Gulf War veterans and their family members. The committee acknowledges the efforts of Department of Defense and Department of Veterans Affairs staff who provided background materials. The committee benefited greatly from the scientific expertise provided by reviewers and colleagues consulted in the course of the study including Neil Miller, Patricia Stewart, and David Zee. The committee values the contributions made by a number of individual consultants including—Miriam Davis, Diane Mundt, Mary Paxton, Elizabeth Tonkin, Marie-France Valois, and Lisa Zimmerman, and the assistance of Applied Epidemiology, Inc., of Amherst, Massachusetts. The committee also appreciates the support of the sponsor, the Department of Veterans Affairs.

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
×

CONTENTS

 

 

EXECUTIVE SUMMARY

 

1

   

 Scope of Volume 2

 

2

   

 Methods

 

2

   

 Drawing Conclusions About the Literature

 

3

   

 Conclusions

 

6

1.

 

INTRODUCTON

 

10

   

 Scope of Volume 2

 

11

   

 Use of Insecticides in the Gulf War

 

12

   

 Use of Solvents in the Gulf War

 

13

   

 Complexities in Addressing Gulf War Health Issues

 

13

   

 Organization of the Report

 

15

   

 References

 

16

2.

 

IDENTIFYING AND EVALUATING THE LITERATURE

 

17

   

 Identifying the Literature

 

17

   

 Drawing Conclusions about the Literature

 

18

   

 Evaluating the Literature

 

21

   

 The Nature and Value of Experimental Evidence

 

34

   

 References

 

36

3.

 

INSECTICIDE TOXICOLOGY

 

39

   

 Organophosphorous Compounds

 

39

   

 Carbamates

 

50

   

 Pyrethrins and Pyrethroids

 

57

   

 Lindane

 

63

   

 N,N-Diethyl-3-Methylbenzamide (DEET)

 

66

   

 References

 

69

4.

 

SOLVENT TOXICOLOGY

 

82

   

 General Solvent Information

 

83

   

 Aromatic Hydrocarbons

 

84

   

 Halogenated Hydrocarbons

 

85

   

 Alcohols

 

89

   

 Glycols

 

90

   

 Glycol Ethers

 

92

   

 Esters

 

93

   

 Ketones

 

94

   

 Petroleum Distillates

 

94

   

 References

 

95

5.

 

CANCER AND EXPOSURE TO INSECTICIDES

 

98

   

 Cancer Overview

 

98

   

 Oral, Nasal, and Laryngeal Cancers

 

101

   

 Gastrointestinal Tract Cancers

 

102

   

 Hepatobiliary Cancers

 

105

   

 Lung Cancer

 

107

   

 Bone Cancer

 

110

   

 Soft Tissue Sarcoma

 

111

   

 Skin Cancer

 

112

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
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 Female Reproductive Cancers

 

114

   

 Urologic Cancers

 

117

   

 Brain and Other Central Nervous System Tumors

 

121

   

 Non-Hodgkin’s Lymphoma

 

123

   

 Hodgkin’s Disease

 

130

   

 Multiple Myeloma

 

132

   

 Adult Leukemia

 

134

   

 Childhood Cancer

 

139

   

 References

 

146

6.

 

CANCER AND EXPOSURE TO SOLVENTS

 

156

   

 Introduction

 

156

   

 Description of the Cohort Studies

 

159

   

 Oral, Nasal, and Laryngeal Cancer

 

179

   

 Gastrointestinal Tract Tumors

 

184

   

 Hepatobiliary Cancers

 

207

   

 Lung Cancer

 

214

   

 Bone Cancer

 

224

   

 Soft Tissue Sarcoma

 

225

   

 Skin Cancer

 

226

   

 Breast Cancer

 

230

   

 Female Reproductive Cancers

 

237

   

 Urologic Cancers

 

241

   

 Brain and Other Central Nervous System Cancers

 

272

   

 Lymphatic and Hematopoietic Cancers

 

282

   

 Non-Hodgkin’s Lymphoma

 

283

   

 Hodgkin’s Disease

 

297

   

 Multiple Myeloma

 

301

   

 Adult Leukemia

 

307

   

 Myelodysplastic Syndromes

 

326

   

 Childhood Cancer

 

331

   

 References

 

339

7.

 

NEUROLOGIC EFFECTS

 

350

   

 Gulf War Veterans Studies

 

353

   

 Insecticides and Peripheral Neuropathy

 

356

   

 Solvents and Peripheral Neuropathy

 

371

   

 Neurobehavioral Effects

 

377

   

 OP Insecticides and Neurobehavioral Effects

 

388

   

 Solvents and Neurobehavioral Effects

 

403

   

 Insecticides and Neurologic Diseases

 

411

   

 Solvents and Neurologic Diseases

 

421

   

 Solvents and Sensory Effects

 

439

   

 References

 

441

8.

 

REPRODUCTIVE AND DEVELOPMENTAL EFFECTS

 

450

   

 Preconception

 

450

   

 Pregnancy

 

461

   

 Congenital Malformations

 

469

   

 References

 

477

9.

 

ADDITIONAL HEALTH EFFECTS

 

484

   

 Aplastic Anemia

 

484

   

 Cardiovascular Effects

 

491

   

 Respiratory Effects

 

494

   

 Hepatic Effects

 

499

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
×

TABLES

TABLE 5.1

 

Selected Epidemiologic Studies—Pancreatic Cancer and Exposure to Insecticides

 

105

TABLE 5.2

 

Selected Epidemiologic Studies—Hepatobiliary Cancers and Exposure to Insecticides

 

107

TABLE 5.3

 

Selected Epidemiologic Studies—Lung Cancer and Exposure to Insecticides

 

109

TABLE 5.4

 

Selected Epidemiologic Studies—Soft Tissue Sarcomas and Exposure to Insecticides

 

112

TABLE 5.5

 

Selected Epidemiologic Studies—Skin Cancers and Exposure to Insecticides

 

114

TABLE 5.6

 

Selected Epidemiologic Studies—Breast Cancer and Exposure to Insecticides

 

116

TABLE 5.7

 

Selected Epidemiologic Studies—Urologic Cancers and Exposure to Insecticides

 

120

TABLE 5.8

 

Selected Epidemiologic Studies—Brain and Other CNS Tumors and Exposure to Insecticides

 

123

TABLE 5.9

 

Selected Epidemiologic Studies—Non-Hodgkin’s Lymphoma and Exposure to Insecticides

 

129

TABLE 5.10

 

Selected Epidemiologic Studies—Hodgkin’s Disease and Exposure to Insecticides

 

131

TABLE 5.11

 

Selected Epidemiologic Studies—Multiple Myeloma and Exposure to Insecticides

 

134

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
×

TABLE 5.12

 

Selected Epidemiologic Studies—Adult Leukemia and Exposure to Insecticides

 

138

TABLE 5.13

 

Selected Epidemiologic Studies—Childhood Leukemia and Exposure to Insecticides

 

145

TABLE 5.14

 

Selected Epidemiologic Studies—Other Childhood Cancers and Exposure to Insecticides

 

146

TABLE 6.1

 

Description of Cohort Studies Related to Exposure to Organic Solvents

 

160

TABLE 6.2

 

Description of Case-Control Studies of Oral, Nasal, and Laryngeal Cancer and Exposure to Organic Solvents

 

180

TABLE 6.3

 

Selected Epidemiologic Studies—Oral Cancer and Exposure to Organic Solvents

 

181

TABLE 6.4

 

Selected Epidemiologic Studies—Nasal Cancer and Exposure to Organic Solvents

 

182

TABLE 6.5

 

Selected Epidemiologic Studies—Laryngeal Cancer and Exposure to Organic Solvents

 

183

TABLE 6.6

 

Description of Case-Control Studies of Gastrointestinal Tract Tumors and Exposure to Organic Solvents

 

185

TABLE 6.7

 

Selected Epidemiologic Studies—Esophageal Cancer and Exposure to Organic Solvents

 

189

TABLE 6.8

 

Selected Epidemiologic Studies—Stomach Cancer and Exposure to Organic Solvents

 

193

TABLE 6.9

 

Selected Epidemiologic Studies—Colon Cancer and Exposure to Organic Solvents

 

197

TABLE 6.10

 

Selected Epidemiologic Studies—Rectal Cancer and Exposure to Organic Solvents

 

202

TABLE 6.11

 

Selected Epidemiologic Studies—Pancreatic Cancer and Exposure to Organic Solvents

 

205

TABLE 6.12

 

Description of Case-Control Studies of Liver Cancer and Exposure to Organic Solvents

 

208

TABLE 6.13

 

Selected Epidemiologic Studies—Hepatobiliary Cancers and Exposure to Organic Solvents

 

211

TABLE 6.14

 

Description of Case-Control Studies of Lung Cancer and Exposure to Organic Solvents

 

215

TABLE 6.15

 

Selected Epidemiologic Studies—Lung Cancer and Exposure to Organic Solvents

 

219

TABLE 6.16

 

Selected Epidemiologic Studies—Bone Cancer and Exposure to Organic Solvents

 

225

TABLE 6.17

 

Description of Case-Control Studies of Melanoma Skin Cancers and Exposure to Organic Solvents

 

227

TABLE 6.18

 

Selected Epidemiologic Studies—Melanoma Skin Cancers and Exposure to Organic Solvents

 

228

TABLE 6.19

 

Selected Epidemiologic Studies—Nonmelanoma Skin Cancers and Exposure to Organic Solvents

 

229

TABLE 6.20

 

Description of Case-Control Studies of Breast Cancer and Exposure to Organic Solvents

 

231

TABLE 6.21

 

Selected Epidemiologic Studies—Breast Cancer and Exposure to Organic Solvents

 

234

TABLE 6.22

 

Selected Epidemiologic Studies—Cervical Cancer and Exposure to Organic Solvents

 

239

TABLE 6.23

 

Selected Epidemiologic Studies—Ovarian Cancer and Exposure to Organic Solvents

 

240

TABLE 6.24

 

Selected Epidemiologic Studies—Uterine and Endometrial Cancer and Exposure to Organic Solvents

 

241

TABLE 6.25

 

Description of Case-Control Study of Prostate Cancer and Exposure to Organic Solvents

 

242

TABLE 6.26

 

Selected Epidemiologic Studies—Prostate Cancer and Exposure to Organic Solvents

 

244

TABLE 6.27

 

Description of Case-Control Studies of Bladder Cancer and Exposure to Organic Solvents

 

248

TABLE 6.28

 

Selected Epidemiologic Studies—Bladder Cancer and Exposure to Organic Solvents

 

254

TABLE 6.29

 

Description of Case-Control Studies of Kidney Cancer and Exposure to Organic Solvents

 

260

TABLE 6.30

 

Selected Epidemiologic Studies—Kidney Cancer and Exposure to Organic Solvents

 

267

TABLE 6.31

 

Description of Case-Control Studies of Brain and Central Nervous System Cancers and Exposure to Organic Solvents

 

273

TABLE 6.32

 

Selected Epidemiologic Studies—Brain and Central Nervous System Tumors and Exposure to Organic Solvents

 

277

TABLE 6.33

 

Description of Case-Control Studies of Non-Hodgkin’s Lymphoma and Exposure to Organic Solvents

 

284

TABLE 6.34

 

Selected Epidemiologic Studies—Non-Hodgkin’s Lymphoma and Exposure to Organic Solvents

 

290

TABLE 6.35

 

Description of Case-Control Studies of Hodgkin’s Disease and Exposure to Organic Solvents

 

298

TABLE 6.36

 

Selected Epidemiologic Studies—Hodgkin’s Disease and Exposure to Organic Solvents

 

299

TABLE 6.37

 

Description of Case-Control Studies of Multiple Myeloma and Exposure to Organic Solvents

 

302

TABLE 6.38

 

Selected Epidemiologic Studies—Multiple Myeloma and Exposures to Organic Solvents

 

304

TABLE 6.39

 

Description of Case-Control Studies of Leukemia and Exposure to Organic Solvents

 

309

TABLE 6.40

 

Selected Epidemiologic Studies—Adult Leukemia and Exposure to Organic Solvents

 

315

TABLE 6.41

 

Selected Epidemiologic Studies—Acute Leukemia and Exposure to Organic Solvents

 

320

TABLE 6.42

 

Selected Epidemiologic Studies—Chronic Leukemia and Exposure to Organic Solvents

 

323

TABLE 6.43

 

Selected Epidemiologic Studies—Lymphatic Leukemia and Exposure to Organic Solvents

 

324

TABLE 6.44

 

Selected Epidemiologic Studies—Hairy Cell Leukemia and Exposure to Organic Solvents

 

325

TABLE 6.45

 

Description of Case-Control Studies of Myelodysplastic Syndromes and Exposure to Organic Solvents

 

328

TABLE 6.46

 

Selected Epidemiologic Studies—Myelodysplastic Syndromes and Exposure to Organic Solvents

 

330

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
×

TABLE 6.47

 

Description of Case-Control Studies of Childhood Cancer and Exposure to Organic Solvents

 

333

TABLE 6.48

 

Selected Epidemiologic Studies—Childhood Leukemia and Exposure to Organic Solvents

 

335

TABLE 6.49

 

Selected Epidemiologic Studies—Childhood Neuroblastoma and Exposure to Organic Solvents

 

337

TABLE 6.50

 

Selected Epidemiologic Studies—Childhood Brain Cancers and Exposure to Organic Solvents

 

338

TABLE 7.1

 

Gulf War Studies and Peripheral Neuropathy

 

357

TABLE 7.2

 

Peripheral Neuropathy and Organophosphorous Insecticide Exposures

 

365

TABLE 7.3

 

Peripheral Neuropathy and Solvent Exposure

 

372

TABLE 7.4

 

Gulf War Studies and Neurobehavioral Effects

 

379

TABLE 7.5

 

Neurobehavioral Effects with History of Past OP Poisoning

 

390

TABLE 7.6

 

Neurobehavioral Effects Without Past History of OP Poisoning

 

394

TABLE 7.7

 

Neurobehavioral Effects and Solvent Exposure

 

405

TABLE 7.8

 

Case-Control Studies of Parkinson’s Disease and Insecticide Exposure

 

414

TABLE 7.9

 

Parkinson’s Disease and Solvent Exposure

 

422

TABLE 7.10

 

Amyotrophic Lateral Sclerosis (Motor Neuron Disease) and Solvents

 

425

TABLE 7.11

 

Multiple Sclerosis and Solvent Exposure

 

431

TABLE 7.12

 

Alzheimer’s Disease and Solvent Exposure

 

435

TABLE 8.1

 

Selected Epidemiologic Studies: Sperm and Semen Parameters and Exposure to Carbaryl

 

455

TABLE 8.2

 

Selected Epidemiologic Studies: Time-to-Pregnancy and Exposure to Insecticides

 

455

TABLE 8.3

 

Selected Epidemiologic Studies: Time-to-Pregnancy and Exposure to Organic Solvents

 

461

TABLE 8.4

 

Selected Epidemiologic Studies: Spontaneous Abortion and Paternal Exposure to Organic Solvents

 

468

TABLE 8.5

 

Selected Epidemiologic Studies: Congenital Malformations and Exposure to Insecticides

 

473

TABLE 8.6

 

Selected Epidemiologic Studies: Congenital Malformations and Exposure to Organic Solvents

 

477

TABLE 9.1

 

Selected Epidemiologic Studies: Aplastic Anemia and Exposure to Insecticides

 

486

TABLE 9.2

 

Selected Epidemiologic Studies: Aplastic Anemia and Exposure to Organic Solvents

 

490

TABLE 9.3

 

Selected Epidemiologic Studies: Hepatic Steatosis and Exposure to Organic Solvents

 

502

TABLE 9.4

 

Selected Epidemiologic Studies: Renal Disease and Exposure to Organic Solvents

 

508

TABLE 9.5

 

Selected Epidemiologic Studies: Systemic Rheumatic Diseases and Exposure to Organic Solvents

 

519

TABLE A.1

 

Demographic Characteristics of US Gulf War Troops

 

534

TABLE A.2

 

Most Frequent Symptoms and Diagnoses 53,835 Participants in VA Registry (1992–1997)

 

535

TABLE A.3

 

Major Studies of Gulf War Veterans’ Symptoms and Syndromes

 

538

TABLE A.4

 

Results of the Iowa Study

 

541

TABLE A.5

 

Results of the VA Study

 

542

TABLE A.6

 

VA Study Percent Distribution of Self-Reported Exposures (n=11,441)

 

543

TABLE C.1

 

Bibliographic Databases

 

566

TABLE C.2

 

Factual Databases

 

566

TABLE E.1

 

Relative Risks for Lung Cancer

 

570

TABLE F.1

 

Neurobehavioral Tests

 

579

FIGURES

FIGURE 3.1

 

Structures of organophosphorous insecticides used in Gulf War

 

41

FIGURE 3.2

 

Structure of carbaryl

 

51

FIGURE 3.3

 

Structures of a) pyrethrin I, b) permethrin, and c) d-phenothrin

 

58

FIGURE 3.4

 

Structure of lindane

 

63

FIGURE 3.5

 

Structure of DEET

 

67

FIGURE 4.1

 

Structure of a) benzene, b) toluene, and c) xylenes

 

85

FIGURE.4.2

 

Metabolic pathways of chloroform biotransformation

 

89

FIGURE 4.3

 

Structure of various alcohols

 

90

FIGURE 4.4

 

Structure of various glycols

 

91

FIGURE 4.5

 

Structure of glycol ethers and their metabolites

 

92

FIGURE 4.6

 

Structure of various esters

 

93

FIGURE 4.7

 

Basic structure of ketones

 

94

Suggested Citation:"Front Matter." Institute of Medicine. 2003. Gulf War and Health: Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press. doi: 10.17226/10628.
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Gulf War and Health, Volume 2, is the second in a series of congressionally-mandated studies by the Institute of Medicine that provides a comprehensive assessment of the available scientific literature on potential health effects of exposure to certain biological, chemical, and environmental agents associated with the Gulf War. In this second study, the committee evaluated the published, peer-reviewed literature on exposure to insecticides and solvents thought to have been present during the 1990-1991 war.

Because little information exists on actual exposure levels – a critical factor when assessing health effects – the committee could not draw specific conclusions about the health problems of Gulf War veterans. However, the study found some evidence, although usually limited, to link specific long-term health outcomes with exposure to certain insecticides and solvents.

The next phase of the series will examine the literature on potential health effects associated with exposure to selected environmental pollutants and particulates, such as oil-well fires and jet fuels.

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