Third in a series of six congressionally mandated studies occurring biennially, this book is an updated review and evaluation of the available scientific evidence regarding the statistical association between exposure to herbicides used in Vietnam and various adverse health outcomes suspected to be linked with such exposures. As part of the review, the committee convened a workshop at which issues surrounding the reanalysis and the combination of existing data on the health effects of herbicide and dioxin exposure were addressed.

This book builds upon the information developed by the IOM committees responsible for the 1994 original report, Veterans and Agent Orange, and Veterans and Agent Orange: Update 1996, but will focus on scientific studies and other information developed since the release of these reports. The two previous volumes have noted that sufficient evidence exists to link soft tissue sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease, and chloracne with exposure. The books also noted that there is "limited or suggestive" evidence to show an association with exposure and a neurological disorder in veterans and with the congenital birth defect spina bifida in veterans' children. This volume will be critically important to both policymakers and physicians in the federal government, Vietnam veterans and their families, veterans organizations, researchers, and health professionals.

Contents

• COMMITTEE TO REVIEW THE HEALTH EFFECTS IN VIETNAM VETERANS OF EXPOSURE TO HERBICIDES (SECOND BIENNIAL UPDATE)
• Preface
• 1. Executive Summary
  • Organization and Framework
  • Toxicology Summary
  • Exposure Assessment
  • Conclusions About Health Outcomes
  • References
• 2. Veterans and Agent Orange: Previous IOM Reports
  • Background
  • Impact of the Reports
  • Federal Government's Response to Concerns over the Military Use of Herbicides in Vietnam
  • References
• 3. Toxicology
  • Summary
  • VAO and Update 1996—Overview
  • Update of the Scientific Literature—Overview
  • Toxicity Profile Updates
  • Issues in Evaluating the Evidence
  • References
• 4. Methodologic Considerations in Evaluating the Evidence
  • Questions to be Addressed
  • Issues in Evaluating the Evidence
  • Summary of the Evidence
  • References
• 5. Exposure Assessment
  • Military Use of Herbicides in Vietnam
  • Occupational and Environmental Exposures to Herbicides and Dioxin
  • Exposure Assessment for Epidemiology
  • Exposure Assessment in Studies of Vietnam Veterans
  • Exposure Assessment in Occupational and Environmental Studies
  • Review of the Scientific Literature
  • References
• 6. Epidemiologic Studies
  • Occupational Studies
  • Environmental Studies
  • Vietnam Veterans Studies
  • References
• 7. Cancer
  • Introduction
  • Gastrointestinal Tract Tumors
  • Hepatobiliary Cancers
  • Nasal/Nasopharyngeal Cancer
  • Laryngeal Cancer
  • Lung Cancer
  • Bone Cancer
  • Soft-Tissue Sarcomas
  • Skin Cancers
  • Melanoma
  • Basal and Squamous Cell (Nonmelanoma) Skin Cancer
  • Breast Cancer
  • Cancers of the Female Reproductive System
  • Prostate Cancer
  • Testicular Cancer
  • Urinary Bladder Cancer
  • Renal Cancer
  • Brain Tumors
  • Non-Hodgkin's Lymphoma
  • Hodgkin's Disease
  • Multiple Myeloma
  • Leukemia
  • Summary
  • References
• 8. Latency and Cancer Risk
  • Analysis of Latency in Epidemiologic Studies
  • Four Questions Addressed By the Committee
  • Review of the Scientific Literature
  • Respiratory Cancer
  • Prostate Cancer
  • Non-Hodgkin's Lymphoma
  • Relevance of Latency in Assessing the Effect of Herbicides On Cancer Risk in Vietnam Veterans
  • References
• 9. Reproductive Effects
  • Introduction
  • Birth Defects
  • Fertility
  • Stillbirth, Neonatal Death, and Infant Death
  • Low Birthweight and Preterm Birth
  • Conclusions for Reproductive Effects
  • References
• 10. Neurobehavioral Disorders
  • Background
  • Cognitive and Neuropsychiatric Effects
  • Motor/Coordination Dysfunction
  • Chronic Persistent Peripheral Neuropathy
  • Acute and Subacute Transient Peripheral Neuropathy
  • Conclusions for Neurobehavioral Disorders
  • References
• 11. Other Health Effects
  • Introduction
  • Chloracne
  • Porphyria Cutanea Tarda
  • Respiratory Disorders
  • Immune System Disorders
  • Diabetes
  • Lipid and Lipoprotein Disorders
  • Gastrointestinal and Digestive Disease, Including Liver Toxicity
  • Circulatory Disorders
  • Summary
  • References
• Appendix A Information Gathering
• Appendix B ICD·9 Codes for Cancer Outcomes
• Appendix C Committee and Staff Biographies

Support for this study was provided by the Department of Veterans Affairs (contract no. V101(93)P-1331).

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.