Veterans and Agent Orange Update 11 (2018) (2018) / Chapter Skim
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12 Conclusions and Recommendations
12 Conclusions and Recommendations
Pages 559-572
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From page 559... ...
SYNOPSIS OF COMMITTEE CONCLUSIONS Under the aegis of Public Law (PL) 102-4, the current committee reviewed and evaluated the available scientific evidence regarding the associations between diseases and exposure to dioxin and other chemical compounds in herbicides used during the Vietnam War.1 In reaching its conclusions, it weighed the strengths and limitations of the epidemiologic evidence reviewed in its report and in previous Veterans and Agent Orange (VAO)
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From page 560... ...
, which are particularly useful for the committee's purpose because they provide a cumulative measure of exposure to all dioxin-like chemicals. The committee also notes that considerable experimental data related to the biologic plausibility of the health conditions statistically associated with exposure to the components of the herbicides sprayed in Vietnam have emerged since the beginning of the VAO report series.
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From page 561... ...
Finally, the committee -- after extensive deliberations regarding the strengths and weaknesses of the new evidence and evidence from studies reviewed in previous VAO reports -- could not come to a consensus on whether the available scientific information regarding exposure to the COIs and type 2 diabetes should continue to be categorized as limited or suggestive or whether it meets the criteria for sufficient evidence of an association (see Chapter 10)
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From page 562... ...
Few of them address Vietnam veterans specifically, however, and almost all of those that were conducted on other populations have weaknesses -- prominently, different exposures than those experienced by veterans and also poor exposure characterization -- that limit their usefulness in assessing risks for veterans. Some find associations between exposures and various outcomes, but there are no circumstances for which there is a consistent and compelling body of evidence that would lead the committee to conclude that there might be limited or suggestive or sufficient evidence of an association between an exposure to a COI and a particular outcome.
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From page 563... ...
Given the absence of new studies, the paucity of epidemiologic studies in general, and the lack of information on the biologic plausibility of a connection between exposures to the COIs and abnormalities of hematopoietic cells associated with nonmalignant bone marrow derived diseases, the committee concluded – that there was inadequate or insufficient evidence of an association between exposure to the COIs and MPNs. Because the outcome has not been subject to previous research attention and is of interest to veterans, the committee recommends that investigators examine existing databases on myeloid diseases to determine whether there are data available that would allow for an evaluation of MPNs in Vietnam veterans and others who have been exposed to dioxin and the other COIs.
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From page 564... ...
The committee believes it is appropriate for VA to be mindful of the concerns raised about the possible association between Vietnam service and glioblastoma, but it observes that the outcome is so rare and the information concerning herbicide exposures so imprecise that it is doubtful that any logistically and economically feasible epidemiologic study of veterans -- no matter how well designed or executed -- would produce meaningful results. The committee therefore recommends that epidemiologic studies of glioblastoma in Vietnam veterans should not be pursued and that VA should instead focus on fostering advancements in other areas that may be used to inform improved treatment options.
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From page 565... ...
Porphyria cutanea tarda Ischemic heart disease Stroke Hypothyroidism The committee did not reach consensus on whether the evidence regarding type 2 diabetes (mellitus) was more properly classified as Sufficient or Limited or Suggestive.
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From page 566... ...
Cancers at other and unspecified sites Infertility Spontaneous abortion (other than after paternal exposure to TCDD, which appears not to be associated) Neonatal or infant death and stillbirth in offspring of exposed people Low birth weight in offspring of exposed people Birth defects in offspring of exposed people, including spina bifida Childhood cancer (including acute myeloid leukemia)
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From page 567... ...
. Generally speaking, the recommendations of previous VAO committees fell into four primary areas: better management of veterans' health information; additional epidemiologic studies; the improvement of exposure estimation; and
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From page 568... ...
indicated that "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 .
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From page 569... ...
EPIDEMIOLOGIC STUDIES Army Chemical Corps (ACC) Study paternally mediated effects on health outcomes in offspring.
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From page 570... ...
Develop epidemiologic protocols to address whether adverse effects are being Update 2010 No known follow-up manifested in later generations as a result of paternal exposure (in the absence of maternal exposure, focusing on those organ systems that have shown the greatest impact following maternal exposure, including neurologic, immune, and endocrine effects)
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From page 571... ...
Animal studies of the mechanisms of inhibition of fetal growth, particularly in Update 2012 No known follow-up male offspring, after maternal exposure could help to elucidate findings seen in some epidemiologic studies that examined maternal exposure and birth weight. Given the current concern among male veterans about the transmission of Update 2014 No known follow-up adverse effects to their descendants, focused use of animal models to investigate the possibility of paternal exposure contributing to the development of disease in offspring would be very informative.
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From page 572... ...
Comprehensive longitudinal analysis of the AFHS data collected in the six intensive medical cycle examinations (including birth defects in veterans' offspring) , making use of the available exposure data.
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