OP insecticide data in its conclusion, the committee reviewed the OP epidemiology literature. The committee responsible for GW2 (IOM, 2003a) reviewed the literature on OP compounds. The present committee reviewed relevant epidemiology studies published since the preparation of that report.

Animal studies had a small role in the committee’s assessment of association between putative agents and health outcomes. As with previous committees, this committee used animal data for making assessments of biologic plausibility in support of the epidemiologic data rather than as part of the weight of evidence to determine the likelihood that an exposure to a specific agent might cause a long-term outcome.

The committee classified the evidence of an association between exposure to sarin and cyclosarin and a specific health outcome into five categories (Box 1-1). The categories closely resemble those used by previous committees that evaluated the effects of chemicals related to the Gulf War (IOM, 2000a, 2003a) and those used by several IOM committees that have evaluated vaccine safety (IOM, 1991, 1994a), herbicides used in Vietnam (IOM, 1994b, 1996, 1999, 2001, 2003b), and indoor pollutants related to asthma (IOM, 2000b). The committee’s conclusions, presented in Chapter 4, represent its collective judgment.

The committee endeavored to express its judgment as clearly and precisely as the available data allowed, and it used the established categories of association from previous IOM studies because they have gained wide acceptance over more

BOX 1-1
Categories of Evidence

Sufficient Evidence of a Causal Relationship

Evidence from available studies is sufficient to conclude that a causal relationship exists between exposure to a specific agent and a specific health outcome in humans, and the evidence is supported by experimental data. The evidence fulfills the guidelines for sufficient evidence of an association (below) and satisfies several of the guidelines used to assess causality: strength of association, dose–response relationship, consistency of association, biologic plausibility, and a temporal relationship.

Sufficient Evidence of an Association

Evidence from available studies is sufficient to conclude that there is a positive association. A consistent positive association has been observed between exposure to a specific agent and a specific health outcome in human studies in which chance1 and bias, including confounding, could be ruled out with reasonable confidence. For example, several high-quality studies report consistent positive associations, and the studies are sufficiently free of bias, including adequate control for confounding.



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