Agent Orange, Leukemia Link Studied

From: "\"Doc\" Melson" <docmelson@docmelson.com>

X-RCPT-TO: <Will@willpete.com>

Dear Readers,

The Associated Press reported;  An analysis released Thursday by the
Institute of Medicine makes the first connection between the childhood
disease "acute myelogenous leukemia" and the pesticide agent orange. It
stops short of saying the link is conclusive.

Anthony J. Principi, secretary of veterans affairs, called the report "very
serious.''

"I'm deeply concerned about the implications for the children of veterans
exposed to Agent Orange,'' Principi said in a telephone interview with the
Associated Press.

Principi also said President Bush has directed him to prepare legislation
to provide assistance for children with the disease.

The Associated Press reported that Rick Weidman, vice president of Vietnam
Veterans of America, said his group is "pleased that they recognized one
additional birth defect in children born to Vietnam veterans.'' But, he
added, it is also very sad news because most of these children have already
died. The median life expectancy for children diagnosed with this type of
leukemia is two years, he noted.

"No firm evidence links exposure to the herbicides with most childhood
cancers, but new research does suggest that some kind of connection exists
between (acute myelogenous leukemia) in children and their fathers'
military service in Vietnam or Cambodia,'' said Irva Hertz-Picciotto, a
professor of epidemiology at the University of North Carolina.

AML ( also known as acute myloid leukemia and acute nonlymphocytic
leukemia.) Acute myelogenous leukemia is a fast-spreading form of leukemia
that originates in bone-marrow cells. It accounts for about eight percent
of all childhood cancers, the report said.

Hertz-Picciotto was chair of the institute committee that prepared the new
report: "Veterans and Agent Orange, Update 2000.''

SUMMARY OF REPORT BY : INSTITUTE OF MEDICINE BELOW
(COMPLETE REPORT CAN BE PURCHASED FROM THE INSTITUTE)

Your Editor,
Jack Henshaw

##### START SUMMARY OF REPORT #####

I N S T I T U T E O F M E D I C I N E
Shaping the Future for Health
VETERANS AND AGENT ORANGE:
UPDATE 2000
Veterans and Agent Orange: Update 2000, is the third comprehensive review
and evaluation of the newly published scientific evidence regarding
associations between health outcomes and exposure to dioxin and other
chemical compounds in herbicides used in Vietnam. In accordance with Public
Law 102-4—the Agent Orange Act of 1991—a committee of the National Academy of
Sciences, Institute of Medicine was asked to determine, to the extent that
available data
permitted meaningful determinations,
New Research Findings in Update 2000
In reaching conclusions on whether a health outcome was associated with
expo-sure
to dioxin and other chemical compounds in herbicides used in Vietnam, the
committee weighed the strengths and limitations of the epidemiologic
evidence in
previous Veterans and Agent Orange reports as well as the newly published
scientific
data. Each health outcome was assigned to one of four categories, listed in
the ac-companying
table. The findings for the following health outcomes have changed
since the Update 1998 report:
· Type 2 diabetes: In a focused report published in 2000, a committee found
that
there was limited/suggestive evidence of an association between exposure to
the herbi-cides
used in Vietnam or the contaminant dioxin and type 2 (adult-onset) diabetes.
Evidence reviewed in this report continues to support that finding.
Previous reports
had found there was inadequate or insufficient evidence to determine
whether an as-sociation
existed.
· Acute myelogenous leukemia in children of veterans: The committee found
there was limited/suggestive evidence of an association between exposure to
the her-bicides
used in Vietnam or the contaminant dioxin and acute myelogenous leukemia
V
1. whether a statistical association with herbicide exposure exists, taking
into
account the strength of the scientific evidence and the appropriateness of
the sta-tistical
and epidemiologic methods used to detect the association;
2. the increased risk of the disease among those exposed to herbicides during
Vietnam service; and
3. whether there is a plausible biologic mechanism or other evidence of a
causal
relationship between herbicide exposure and the disease.
…a committee found
that there was lim-ited/
suggestive evi-dence
of an associa-tion
between expo-sure
to the herbicides
used in Vietnam or
the contaminant di-oxin
and type 2 (adult-onset)
diabetes.

2
(AML) in the children of veterans. AML is a cancer of the bone marrow cells
that form
two types of white blood cells called granulocytes and monocytes.
In particular, two recently published epidemiologic studies support this
conclusion.
One is a case-control study of AML in which self-reported service in
Vietnam or Cambo-dia
was associated with an elevated risk, after adjustment for numerous
potentially con-founding
life-style and sociodemographic factors. The second, a study of the children
of
Australian Vietnam veterans, found a greater than fourfold risk, although
confounding
factors other than age and gender were not controlled. While direct
measures of exposure
are lacking, the committee found the following characteristics of these
studies to be par-ticularly
persuasive: (1) both were conducted in Vietnam veteran populations; (2) the
as-sociation
was specific for AML, with no excess risk found for other forms of leukemia;
(3) one study adjusted for numerous confounders, while the other had an
association of
sufficiently large magnitude to reduce the likelihood of being completely
due to con-founding;
and (4) the strongest association was seen in children diagnosed at the
young-est
ages—cases that are considered the strongest candidates for an etiology of
parental
origin. These characteristics diminish the likelihood that the outcomes
were unrelated to
service in Vietnam. A third study, which reported a 2.7-fold increased risk
of AML in the
children of fathers with self-reported exposure of more than 1,000 days to
pesticides or
weed killers, adds to the plausibility that herbicide exposure could be
related to the higher
risk observed among those who served in Vietnam.
· AL-type primary amyloidosis: In response to a request from the Department of
Veterans Affairs, the committee examined the possible association between
the herbi-cides
of concern in this report and AL-type primary amyloidosis, a rare bone
marrow dis-ease
not examined in previous Veterans and Agent Orange reports. They found that
there
was inadequate information to determine whether an association existed.
Other Findings
The report also reaffirms findings in earlier reports that there is
sufficient evidence of
an association between herbicide or dioxin exposure and soft tissue
sarcoma, non-Hodgkin's
lymphoma, Hodgkin's disease, and chloracne in veterans. In Update 1998, the
committee found limited/suggestive evidence of an association for three
cancers—respi-ratory
(larynx, lung or bronchus, and trachea) cancer, prostate cancer, and
multiple mye-loma—
and three other health outcomes—spina bifida in the children of veterans,
acute
and subacute (transient) peripheral neuropathy, and porphyria cutanea
tarda. The recent
scientific literature continues to support the classification of these
diseases in the lim-ited/
suggestive category of evidence.
The scientific data for many of the cancers and other diseases reviewed by
the com-mittee
were inadequate or insufficient to determine whether an association exists.
For
two types of cancers—gastrointestinal tumors and brain tumors—the latest
literature sup-ported
earlier findings that there was limited/suggestive evidence of no
association with
the exposures of interest. A complete listing of the conditions considered
by the com-mittee
and their findings concerning them is contained in the accompanying table.
The committee found
there was lim-ited/
suggestive evi-dence
of an associa-tion
between expo-sure
to the herbicides
used in Vietnam or
the contaminant di-oxin
and acute mye-logenous
leukemia
(AML) in the children
of veterans.
…the committee ex-amined
the possible
association between
the herbicides of
concern in this report
and AL-type primary
amyloidosis, a rare
bone marrow disease
not examined in pre-vious
Veterans and
Agent Orange re-ports.
They found
that there was inade-quate
information to
determine whether an
association existed.

3
Updated (2000) Summary of Findings in Occupational, Environmental, and
Veterans Studies
Regarding the Association Between Specific Health Outcomes and Exposure to
Herbicides
Sufficient Evidence of an Association
Evidence is sufficient to conclude that there is a positive association.
That is, a positive association has been
observed between herbicides and the outcome in studies in which chance,
bias, and confounding could be ruled out
with reasonable confidence. For example, if several small studies are free
from bias and confounding and show an
association that is consistent in magnitude and direction, there may be
sufficient evidence for an association. There
is sufficient evidence of an association between exposure to herbicides and
the following health outcomes:
Soft-tissue sarcoma
Non-Hodgkin’s lymphoma
Hodgkin’s disease
Chloracne
Limited/Suggestive Evidence of an Association
Evidence is suggestive of an association between herbicides and the outcome
but is limited because chance, bias,
and confounding could not be ruled out with confidence. For example, at
least one high-quality study shows a
positive association, but the results of other studies are inconsistent.
There is limited/suggestive evidence of an
association between exposure to herbicides and the following health outcomes:
Respiratory cancers (lung/bronchus, larynx,
trachea)
Prostate cancer
Multiple myeloma
Acute and subacute transient peripheral neuropathy
Porphyria cutanea tarda
Type 2 diabetes (category change from Update 1998)
Spina bifida in the children of veterans
Acute myelogenous leukemia (AML) in the children
of veterans (category change from Update 1998)
Inadequate/Insufficient Evidence to Determine Whether an Association Exists
The available 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. There is inadequate or
insufficient evidence to determine whether
an association exists between exposure to herbicides and the following
health outcomes:
Hepatobiliary cancers
Nasal/nasopharyngeal cancer
Bone cancer
Breast cancer
Female reproductive cancers (cervical,
uterine, ovarian)
Urinary bladder cancer
Renal cancer
Testicular cancer
Leukemia
Skin cancers
Spontaneous abortion
Birth defects (other than spina bifida)
Neonatal/infant death and stillbirths
Low birthweight
Childhood cancer in offspring, other than acute
myelogenous leukemia
Abnormal sperm parameters and infertility
Motor/coordination dysfunction
Chronic peripheral nervous system disorders
Metabolic and digestive disorders (changes in liver
enzymes, lipid abnormalities, ulcers)
Immune system disorders (immune suppression and
autoimmunity)
Circulatory disorders
Respiratory disorders
AL-type primary amyloidosis (new health outcome)
Limited/Suggestive Evidence of No Association
Several adequate studies, covering the full range of levels of exposure
that human beings are known to encounter,
are mutually consistent in not showing a positive association between
exposure to herbicides and the outcome at
any level of exposure. A conclusion of “no association” is inevitably
limited to the conditions, level of exposure,
and length of observation covered by the available studies. In addition,
the possibility of a very small elevation in
risk at the levels of exposure studied can never be excluded. There is
limited/suggestive evidence of no association
between exposure to herbicides and the following health outcomes:
Gastrointestinal tumors (stomach cancer, pancreatic cancer, colon cancer,
rectal cancer)
Brain tumors
NOTE: “Herbicides” refers to the major herbicides used in Vietnam: 2,4-D
(2,4-dichlorophenoxyacetic acid), 2,4,5-T (2,4,5-
trichlorophenoxyacetic acid) and its contaminant TCDD
(2,3,7,8-tetrachlorodibenzo-p-dioxin), cacodylic acid, and picloram. The
evidence regarding association is drawn from occupational and other studies
in which subjects were exposed to a variety of herbicides
and herbicide components.

4
For More Information…
Copies of Veterans and Agent Orange: Update 2000 are available for sale
from the Na-tional
Academy Press; call (800) 624-6242 or (202) 334-3313 (in the Washington
metro-politan
area), or visit the NAP home page at www.nap.edu. The full text of this
report is
available at www.nap.edu.
This study was funded by the U.S. Department of Veterans Affairs.
The Institute of Medicine is a private, nonprofit organization that
provides health policy
advice under a congressional charter granted to the National Academy of
Sciences. For
more information about the Institute of Medicine, visit the IOM home page at
www.iom.edu.
Copyright ©2001 by the National Academy of Sciences. All rights reserved.
Permission is granted to reproduce this document in its entirety, with no
additions or al-terations.
COMMITTEE TO REVIEW THE HEALTH EFFECTS IN VIETNAM
VETERANS OF EXPOSURE TO HERBICIDES (THIRD BIENNIAL UPDATE)
Irva Hertz-Picciotto, Ph.D. (Chair),1,2 University of North Carolina at
Chapel Hill
Margit L. Bleecker, M.D., Ph.D., Center for Occupational and Environmental
Neurology
Thomas A. Gasiewicz, Ph.D., University of Rochester
Tee L. Guidotti, M.D., M.P.H., The George Washington University School of
Public Health and
Health Services
Robert Herrick, Ph.D., C.I.H.,1,2 Harvard School of Public Health
David G. Hoel, Ph.D., 1,2 Medical University of South Carolina
Loren D. Koller, D.V.M., Ph.D, Oregon State University
Howard Ozer, M.D., Ph.D.,1,2 University of Oklahoma
John J. Stegeman, Ph.D., Woods Hole Oceanographic Institution
David S. Strogatz, Ph.D., M.S.P.H., State University of New York at Albany
Staff
David A. Butler, Study Director
Michelle Catlin, Program Officer
James Bowers, Research Assistant
Jennifer A. Cohen, Research Assistant
Rose Marie Martinez, Director, Division of Health Promotion and Disease
Prevention
Marjan Najafi, Research Associate
Patricia Spaulding, Project Assistant
Anna Staton, Project Assistant
Kathleen Stratton, Acting Director (1997–1999), Division of Health
Promotion and Diseas

 

++++++++++++++++++++++++++++++++++++++++++++++++++++++

 

 

"When the way comes to an end, then change - having changed, you pass through."    I. Ching

 

 

http://www.docmelson.com/

http://www.docmelson.com/fifthdivision/

http://www.docmelson.com/acompany/index.html

http://www.docmelson.com/MedicsPlace/index.htm