The planned reanalyses of the preterm-birth and fetal-growth study should be completed as soon as possible, taking advantage of the corrected exposure information that is available but not awaiting more extensive water modeling. Reanalyses should include development of a detailed written analysis plan (for example, Sheppard 2008). Careful attention should be paid to confounding, given the associations between residence and indicators of risk. Given the inherent limitations of birth-certificate data, sensitivity analyses to address gestational-age misclassification, subgroup analyses, and confounding should be incorporated. Finally, future reports should provide full details of the approach, results, and sensitivity analyses; the STROBE (strengthening the reporting of observational studies in epidemiology) guidelines (Vandenbroucke et al. 2007) would be suitable for such documentation. Despite the limited scientific benefit of this effort, the modest cost justifies its prompt completion.
The current case-control study of birth defects and childhood cancer should be completed, given the effort already invested, despite severely limited statistical power. The same recommendations noted for the study of preterm birth and fetal growth apply here as well, including careful planning of analytic methods and full documentation. Relative to the overall effort expended thus far, the committee recognizes the need for completion of this study.
It could be argued that additional studies of the potential health effects from the historical contamination of drinking water at Camp Lejeune could help guide decisions on how to resolve the claims of former residents. Beyond its scientific merit, a more thorough evaluation of health patterns of former Camp Lejeune residents could be seen as providing a valuable public-health service in providing documentation of the experience of former residents and perhaps characterizing the population better. However, on the basis of what is known about the contamination of water supplies at Camp Lejeune; the size, age, and residential mobility of the residents; and the availability of records, the committee concludes that it would be extremely difficult to conduct direct epidemiologic studies of sufficient quality and scope to make a substantial contribution to resolving the health concerns of former Camp Lejeune residents. Conduct of research that is deficient in those respects not only would waste resources but has the potential to do harm by generating misleading results that erroneously implicate or exonerate the exposures of concern.
New studies should be undertaken only if their feasibility and promise of providing substantially improved knowledge on whether health effects have resulted from water exposure at Camp Lejeune are established in advance.
Decisions regarding the appropriate policy response to health concerns about exposure to contaminated water at Camp Lejeune should not be delayed or await the results of epidemiologic studies that are in progress or planned inasmuch as those studies are unlikely to provide definitive information on potential health effects.