I’ve the lead news article tonight in Nature with an exclusive — Further delays to full Agent Orange study — on a complex story behind efforts to get done a large-scale epidemiological study of the health effects, and other combat factors — on Vietnam veterans, almost 30 years after it was first mandated. Nature has an accompanying Editorial — A ghost of battles past.
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A few excerpts from the long news article, and the Editorial, below:
A study to investigate the health effects of Agent Orange on Vietnam War veterans is being obstructed by the US Department of Veterans Affairs (VA), claim scientists and veterans’ organizations.
In 2003, the US Institute of Medicine (IOM) recommended that the VA should commission a large-scale, independent epidemiological study on how the herbicide affected the health of veterans. The recommendation received strong bipartisan backing by both congressional and Senate veterans committees. But five years later, the VA has yet to act, and instead has pursued its own $700,000 internal study to ‘validate’ the models endorsed by the IOM. The VA also asked a different panel of experts at the IOM — not involved in Agent Orange research — to look again at whether such a study was needed. It reached much the same conclusions as the first panel.
“The whole thing makes me very sad, as we have lost five years,” says Jeanne Stellman, an Agent Orange expert now at SUNY Downstate Medical Center in New York, who doubts that the department will ever support the study.
It was a paper by Stellman and her colleagues (J. M. Stellman at al. Nature 422, 681–687 ; 2003) that prompted the IOM’s initial recommendations. Her team analysed data from flight records of US military aircraft and provided the most detailed computerized maps — or geographical information systems — of where, when and how much herbicide was sprayed in Vietnam. The US Air Force sprayed Agent Orange from 1961 to 1971 to wipe out the jungle vegetation concealing their Viet Cong opposition. Stellman’s team calculated that four times more dioxin was sprayed than had previously been estimated. Her system could allow researchers to combine data on the positions of individual troops and databases of the health of veterans and so make a study feasible, the IOM decided.
The IOM’s latest report says that the in-house research the VA has launched cannot meet its stated goal of validating the model, is “insufficient” and “falls short of the complete array of work that the committee believes would be appropriate”. “Not to follow up on the Stellman work would be missing an opportunity,” says David Savitz, chair of the IOM panel and an epidemiologist at Mount Sinai School of Medicine in New York.
Congress first mandated such a large-scale epidemiological study in 1979. But the US Centers for Disease Control and Prevention in Atlanta, Georgia, cancelled it, handing back much of the $70-million funding, arguing that a pilot study showed that it was impossible to disentangle the effects of Agent Orange from other causes. Many politicians and scientists argued at the time that the study was politically rigged to fail.
John Sommer, executive director of the Washington office of the American Legion, the nation’s largest veterans’ organization, says he intends to renew discussions with Congress and the VA. “We will push to have the study done.”
And from the Editorial:
Even by government standards, a near 30-year delay in getting a study approved is extreme. But that is essentially what has happened with a proposed large-scale epidemiological study of the possible effects of the defoliant Agent Orange and other combat factors on US veterans of the Vietnam War. This US administration, or the next, would do well to heed the advice issued last month by the National Academy of Sciences that such a study should now proceed.
It is time to stop stalling. It is true that veterans would not be the first choice for a study on the toxicity of herbicides and dioxins — better-documented accidental exposures would be preferable. But that misses the point. The proposed study is both a legitimate research opportunity and a moral imperative. There are privacy issues with medical and other records, but these are not insurmountable.
And there is a bigger picture. US veterans are not the only ones suffering as a result of the Vietnam War. So scientists and the US and Vietnamese governments need to revive stalled bilateral collaborations (see Nature 434, 687; 2005) on the health effects of Agent Orange on the Vietnamese population itself. The responsibilities of warfare do not end on the battlefield, nor can they be limited by the battle lines that once divided friend from foe.