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Summary
Pages 1-12

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From page 1...
... The herbicide mixtures used were named according to the colors of identification bands painted on the storage drums; the main chemical mixture sprayed was Agent Orange (a 50:50 mixture of 2,4-D and 2,4,5-T)
From page 2...
... " the following regarding associations between specific health outcomes and exposure to TCDD and other chemicals in herbicides used by the military in Vietnam: A)  hether a statistical association with herbicide exposure exists, taking into w account the strength of the scientific evidence and the appropriateness of the statistical and epidemiological methods used to detect the association; B)
From page 3...
... Second, the committee was asked to comment on whether effects of herbicide exposure might be manifested at later stages of a child's development than have systematically been evaluated to date or in later generations and on the feasibility of assessing such effects. COMMITTEE'S APPROACH TO ITS CHARGE Following the pattern established by prior VAO committees, the present committee concentrated its review on epidemiologic studies to fulfill its charge of assessing whether specific human health effects are associated with exposure to at least one of the herbicides sprayed in Vietnam or to TCDD.
From page 4...
... Most important, the Vietnam veterans themselves are advancing in age and, when studied, are capable of providing substantial information on chronic health conditions directly. As the information in the database on populations with established exposures to the chemicals of interest has grown, the committee has come to depend less on data from studies with nonspecific exposure information and has been able to focus more on findings of studies with refined exposure specificity.
From page 5...
... It has been the practice of all VAO committees to evaluate all studies according to the same criteria and then to weight findings of similar strength and validity equivalently, whether or not the study subjects are Vietnam veterans, when drawing conclusions. The committee recognizes that an absolute conclusion about the absence of association might never be attained, because, as is generally the case in science, studies of health outcomes after herbicide exposure cannot demonstrate that a purported effect is impossible, only that it is statistically improbable.
From page 6...
... Data from the National Health and Nutrition Examination Survey were used in several studies of health outcomes, including hypertension, cardiovascular disease, diabetes, and increased concentrations of lipids in relation to serum concentrations of dioxin-like compounds. New case–control studies examined occupational and environmental exposures to the chemicals of interest and other risk factors for various reproductive and cancer outcomes and for PD.
From page 7...
... Hodgkin's disease Chloracne Limited or Suggestive Evidence of an Association Epidemiologic evidence suggests an association between exposure to herbicides and the outcome, but a firm conclusion is limited because chance, bias, and confounding could not be ruled out with confidence.b For example, a well-conducted study with strong findings in accord with less compelling results from studies of populations with similar exposures could constitute such evidence. There is limited or suggestive evidence of an association between exposure to the chemicals of interest and the following health outcomes: Laryngeal cancer Cancer of the lung, bronchus, or trachea Prostate cancer Multiple myeloma AL amyloidosis Early-onset transient peripheral neuropathy Parkinson's disease (category change from Update 2006)
From page 8...
... By default, any health outcome on which no epidemiologic information has been found falls into this category. Limited or Suggestive Evidence of No Association Several adequate studies, which cover the full range of human exposure, are consistent in not showing a positive association between any magnitude of exposure to the herbicides of interest and the outcome.
From page 9...
... The committee concluded that ischemic heart disease should move from the category of "inadequate or insufficient evidence of an association" into the category of "limited or suggestive evidence of an association." Several pieces of new information specifically on exposure to the chemicals of interest led the committee to decide that PD should also be promoted from the "inadequate or insufficient evidence" category into the "limited or suggestive evidence" category. These changes to the classifications made in the previous update are bolded in Table S-1.
From page 10...
... For outcomes categorized as having "sufficient" or "limited or suggestive" evidence of an association with herbicide exposure, the lack of exposure information on Vietnam veterans prevents calculation of precise risk estimates. The information needed for assigning risk estimates continues to be absent despite concerted efforts to model the exposure of the troops in Vietnam, to measure the serum TCDD concentrations of individual veterans, and to model the dynamics of retention and clearance of TCDD in the human body.
From page 11...
... The committee notes that the earlier investment in studying several exposed populations is now producing useful findings; the National Institute for Occupational Safety and Health, Seveso, Air Force Health Study, and Army Chemical Corps cohorts all merit continuing follow-up or more comprehensive analysis. It is especially important that longitudinal analyses be conducted on cancer and reproductive outcomes represented in the complete database assembled in the course of the Air Force Health Study.
From page 12...
... 12 VETERANS AND AGENT ORANGE: UPDATE 2008 that work needs to be undertaken promptly to resolve questions regarding several health outcomes, most urgently tonsil cancer, melanoma, and paternally transmitted transgenerational effects. Creative analysis of VA's own data resources and further work on cohorts that have already been established may well be the most effective way to address those outcomes and to gain a better understanding of the role of herbicide exposure in development of PD in Vietnam veterans.


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