Orange: Health Effects of Herbicides Used in Vietnam (hereafter referred to as VAO). The work of later committees resulted in the publication of biennial updates (Update 1996, Update 1998, and Update 2000) and focused reports reviewing the scientific evidence regarding type 2 (non-insulin dependent) diabetes (Type 2 Diabetes), and acute myelogenous leukemia in children (Acute Myelogenous Leukemia). This report is the fourth review of recently published scientific evidence regarding associations between health outcomes and exposure to TCDD and other chemical compounds in herbicides used in Vietnam.

THE CHARGE TO THE COMMITTEE

In accordance with PL 102-4, the Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Fourth Biennial Update) was asked “to determine (to the extent that available data permit meaningful determinations)” the following regarding associations between specific health outcomes and exposure to TCDD and other chemical compounds in herbicides:

A) whether a statistical association with herbicide exposure exists, taking into account the strength of the scientific evidence and the appropriateness of the statistical and epidemiological methods used to detect the association;

B) the increased risk of the disease among those exposed to herbicides during service in the Republic of Vietnam during the Vietnam era; and

C) whether there exists a plausible biological mechanism or other evidence of a causal relationship between herbicide exposure and the disease.

In conducting its study, this committee operated independently of the Department of Veterans Affairs (VA) and other government agencies. The committee was not asked to and did not make judgments regarding specific cases in which individual Vietnam veterans have claimed injury from herbicide exposure. This report provides scientific information for the secretary of veterans affairs to consider as VA exercises its responsibilities to Vietnam veterans.

THE COMMITTEE'S APPROACH TO ITS CHARGE

To fulfill its charge of assessing whether a given human health effect is associated with exposure to at least one of the herbicides or TCDD, the committee concentrated on reviewing and interpreting epidemiologic studies. Experimental investigations that might contribute to biologic plausibility that the chemicals of interest might be related to a given effect were also reviewed. The committee began its evaluation presuming neither the presence nor the absence of associations.

To obtain all information potentially relevant to the evaluation of health effects related to herbicide exposure, the present committee, in addition to re-



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