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1 Introduction
Pages 17-28

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From page 17...
... to conduct an independent comprehensive review and evaluation of scientific and medical information regarding the health effects of exposure to herbicides used during military operations in Vietnam. The herbicides picloram and cacodylic acid were to be addressed, as were chemicals in various formulations containing the herbicides 2,4-dichlorophenoxyacetic acid (2,4-D)
From page 18...
... CHARGE TO THE COMMITTEE In accordance with PL 102-4, the committee was asked to "determine (to the extent that available scientific data permit meaningful determinations) " the following regarding associations between specific health outcomes and exposure to TCDD and other chemical compounds in herbicides: A)
From page 19...
... CONCLUSIONS OF PREVIOUS VETERANS AND AGENT ORANGE REPORTS Health Outcomes VAO, Update 1996, Update 1998, Update 2000, Update 2002, Update 2004, Type 2 Diabetes, Acute Myelogenous Leukemia, and Respiratory Cancer provide detailed reviews of the scientific studies evaluated by the committees and their implications for cancer, reproductive and developmental effects, neurobehavioral disorders, and other health effects. The original committee addressed the statutory mandate to determine whether there is a statistical association between a given health effect and herbicide exposure by assigning each of the health outcomes under study to one of four categories on the basis of the epidemiologic evidence reviewed.
From page 20...
... The committee regarded evidence from several small studies that have satisfactorily addressed bias and confounding and that show an association that is consistent in magnitude and direction as sufficient evidence of an association. The original committee found sufficient evidence of an association between exposure to herbicides and three cancers -- soft-tissue sarcoma, non-Hodgkin's lymphoma, and Hodgkin's disease -- and two other health outcomes, chloracne and porphyria cutanea tarda (PCT)
From page 21...
... b Neonatal or infant death and stillbirth in offspring of exposed people Low birth weight in offspring of exposed people Birth defects (other than spina bifida) in offspring of exposed people Childhood cancer (including acute myelogenous leukemia)
From page 22...
... The Update 1996 committee added three health outcomes to the list: PCT, acute and subacute transient peripheral neuropathy (hereafter called early-onset transient
From page 23...
... The committee for Update 2000 was reconvened to re-evaluate the previously reviewed and new literature regarding that illness. It produced the Acute Myelogenous Leukemia report, which reclassified AML in children from "limited or suggestive evidence of an association" to "inadequate evidence to determine an association." Health Outcomes with Inadequate or Insufficient Evidence to Determine an Association By default, any health outcome is in this category before enough reliable scientific data accumulate to promote it to the category of sufficient evidence or limited or suggestive evidence of an association or to the category of limited or suggestive evidence of no association.
From page 24...
... In Update 2002, CLL was moved from this category to join Hodgkin's and non-Hodgkin's lymphomas in the category of sufficient evidence of an association. Health Outcomes with Limited or Suggestive Evidence of No Association The original VAO committee defined this category for health outcomes for which there were several adequate studies covering the "full range of human exposure" that were consistent in showing no association between exposure to herbicides at any level and the outcome and that had relatively narrow confidence intervals.
From page 25...
... Most of the evidence on which the findings regarding associations are based, therefore, comes from studies of people exposed to TCDD or herbicides in occupational and environmental settings rather than from studies of Vietnam veterans. The committees that produced VAO and the updates found that the body of evidence was sufficient for reaching conclusions about statistical associations between herbicide exposures and health outcomes but that the lack of adequate data on Vietnam veterans themselves complicated consideration of the second part of the charge.
From page 26...
... Even if one accepts an individual veteran's serum TCDD level as the optimal surrogate for his overall exposure to Agent Orange and the other herbicide mixtures sprayed in Vietnam, not only is the measurement nontrivial but the hurdle of accounting for biologic clearance and extrapolating to the proper timeframe remains. The committee therefore believes that it cannot accurately estimate the risk to Vietnam veterans that is attributable to exposure to the compounds associated with herbicide spraying in Vietnam.
From page 27...
... Chapter 3 updates the toxicology data on the effects of 2,4-D, 2,4,5-T and its contaminant TCDD, cacodylic acid, and picloram; those data contribute to the biologic plausibility of health effects in human populations. Chapter 4 provides an overview of populations repeatedly studied in the course of investigating the toxic potential of the chemicals of interest in this report; it also gives design information on the epidemiologic studies new in this update that investigated those populations or that report multiple health outcomes.
From page 28...
... 1994. Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam.


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