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12 Research Recommendations
Pages 721-732

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From page 721...
... Consistent with this mandate, two considerations have guided the committee's research recommendations. First, as discussed in Chapter 6, the interpretation of existing epidemiologic studies is compromised by the frequent lack of appropriate individual measures of exposure to herbicides or TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin)
From page 722...
... The Ranch Hand cohort includes the Vietnam veterans with the highest documented exposure to herbicides, and the committee endorses continuation of the planned follow-up, including both mortality and morbidity studies. Because they will be available at three points in time, the serum TCDD measurements from this study are particularly important to better understand TCDD metabolism and to assess its use as a biomarker to further analyze health effects.
From page 723...
... Prompt collection and storage of biological samples and determination of serum TCDD levels for these additional highly exposed veterans would enhance future epidemiologic studies of health outcomes. Further study of both groups is likely to yield information on a number of health outcomes for which additional research is needed.
From page 724...
... In particular, Chapter 6 proposes measures that are not dependent on serum TCDD levels (which the committee finds inappropriate for the full range of herbicide exposures) but instead recommends the use of less formal sources of historical information about base perimeter spraying and other relevant exposures, as discussed below in Recommendation 4.
From page 725...
... The military reports and personal testimony reviewed by the committee suggest that a sufficient range of exposure to herbicides may exist among Vietnam veterans for valid epidemiologic studies of certain health outcomes, and the committee believes that it is possible to develop valid exposure reconstruction models for epidemiologic studies using methods of historical exposure reconstruction. Such models would estimate the likelihood that each individual veteran was exposed to herbicides in Vietnam and possibly quantify their degree of exposure.
From page 726...
... The exposure reconstruction models developed according to Recommendation 4 should be evaluated by an independent, nongovernmental scientific panel established for this purpose. Herbicide exposure reconstruction models for Vietnam veterans must be evaluated thoroughly before epidemiologic studies based on these models proceed.
From page 727...
... Since Vietnam veterans are expected to have relatively few additional children because of their age, reanalyses of existing reproductive data, especially those based on registries, with the new exposure reconstruction measures proposed in this chapter, would be especially relevant. In particular, the committee believes that extensive reanalysis of the Ranch Hand reproductive data could shed additional light on these questions (see Chapter 9 and Appendix C)
From page 728...
... This includes the development and use of informal information on perimeter spraying, which might account for more meaningful herbicide exposure than the aerial spraying documented on the HERBS tapes. Finally, the committee does not know whether the approach it proposes will prove valid or whether new methods will identify a sufficient number of highly exposed Vietnam veterans for an epidemiologic study.
From page 729...
... With regard to the need for a series of scientific "studies on the feasibility of conducting additional scientific research on" health hazards resulting from exposure to TCDD and herbicides used in Vietnam, the research mandate in section 8 of Public Law 102-4, the committee feels that a series of epidemiologic studies of veterans could yield valuable information if a new, valid exposure reconstruction model can be developed. The committee finds value in continuing the existing Ranch Hand study and expanding it to include Army Chemical Corps veterans.
From page 730...
... Balancing the strengths and weaknesses of stored biological samples and clinical data for research purposes, the committee feels that systems of this sort have scientific value, but only to the extent that they are components of specific, well-designed studies. In the absence of a clear study design to guide such activities and without resolution of the design, quality control, and ethical issues the committee does not recommend the establishment of the clinical data and tissue archiving systems described in sections 6 and 7 of the law at this time.
From page 731...
... Additional, carefully conducted epidemiologic studies with adequate sample size to detect elevated associations of the reproductive history of individuals with occupational or environmental exposure to herbicides and dioxin are also needed. Studies of the Vietnamese population exposed to herbicides are also possible and potentially useful.
From page 732...
... 1987. Letter to GV Montgomery dated September 24, 1987 regarding CDC's study "Comparison of Serum Levels of 2,3,7,8-TCDD with Indirect Estimates of Agent Orange Exposure in Vietnam Veterans" and the proposed protocol for the Women Vietnam Veterans Health Study.


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