Veterans and Agent Orange Update 2008 (2009) / Chapter Skim
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10 Conclusions and Recommendations
10 Conclusions and Recommendations
Pages 651-662
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From page 651... ...
Epidemiologic methods and analytic capabilities have improved, but many of the recent studies were also particularly useful for the committee's purpose because they produced results in terms of serum TCDD concentrations or because their findings consisted of observations on the aging population of primary concern, Vietnam veterans. The committee also notes that experimental data related to biologic plausibility of health conditions statistically associated with exposure to the components of Agent Orange has gradually emerged since the beginning of this series of VAO reports.
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From page 652... ...
Spina bifida in offspring of exposed people Inadequate or Insufficient Evidence to Determine an Association The available epidemiologic studies are of insufficient quality, consistency, or statistical power to permit a conclusion regarding the presence or absence of an association. For example, studies fail to control for confounding, have inadequate exposure assessment, or fail to address latency.
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From page 653... ...
Cancers at other and unspecified sites Infertility Spontaneous abortion (other than after paternal exposure to TCDD, which appears not to be associated) 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)
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From page 654... ...
. Because the committee for Update 2006 could not reach consensus, ischemic heart disease had remained in the category of "inadequate or insufficient evidence to determine an association," but accruing evidence convinced the present committee to move ischemic heart disease from the category of "inadequate or insufficient evidence to determine an association" to the category of "limited or suggestive evidence of an association" with hypertension.
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From page 655... ...
on the fate of TCDD when seawater is distilled to produce drinking water, the committee is convinced that this use of seawater would provide a feasible route of exposure of personnel in the Blue Water Navy, which might have been supplemented by drift from herbicide spraying. The epidemiologic evidence itself supports a broader definition of Vietnam service to serve as a surrogate for presumed exposure to Agent Orange or other herbicides sprayed in Vietnam.
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From page 656... ...
Particular attention should be paid to the feasibility of conducting epidemiologic studies of conditions that have been noted to be of special interest but on which the current evidence is inadequate or insufficient to determine whether there is an association with herbicide exposure (such as tonsil and breast cancers, melanoma, amyotrophic lateral sclerosis, lupus, ischemic heart disease, and stroke)
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From page 657... ...
We reiterate that committee's statement that "no other epidemiologic dataset on Vietnam veterans contains as detailed information over as long a time period, the data appear to be of high quality and the specimens well preserved, and analysis of the assets has contributed to the literature addressing the health of Vietnam veterans." Congress directed the Institute of Medicine (IOM) Medical Follow-up Agency (MFUA)
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From page 658... ...
to this dataset. The committee also notes that future analyses of health outcomes in those and other important study populations should be as specific as possible because generic findings, such as those for "all respiratory outcomes," are not useful in addressing the committee's charge of determining associations of herbicide exposures with specific health conditions.
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From page 659... ...
overall showed significant association, pointing to the need to examine closely both the biologic plausibility of paternally mediated birth defects and the existing epidemiologic evidence. Reviews have also focused on epidemiologic studies of data from birth-defects registries and from parental reports of birth defects.
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From page 660... ...
The plausibility of birth defects arising from parental exposure, especially from paternal exposure, merits careful review in light of newly hypothesized epigenetic mechanisms (such as heritable forms of gamete imprinting) that might make paternal transmission of a TCDD effect more plausible.
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From page 661... ...
Focused study of Vietnam veterans themselves would be especially appropriate for extremely rare conditions, such as tonsil cancer, which appears anecdotally to be occurring at an unusual rate in Vietnam veterans and in connection with which the study of surrogate populations (even with a case–control design) might exclude factors that are important for the military situation.
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From page 662... ...
2005. Did TCDD exposure or service in Southeast Asia increase the risk of cancer in Air Force Vietnam veterans who did not spray Agent Orange?
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