Characterizing Exposure of Veterans to Agent Orange and Other Herbicides Used in Vietnam

Scientific Considerations Regarding a Request for Proposals for Research

Committee on the Assessment of Wartime Exposure to Herbicides in Vietnam

Division of Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.
1997



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Characterizing Exposure of Veterans to Agent Orange and Other Herbicides Used in Vietnam: Scientific Considerations Regarding a Request for Proposals for Research Characterizing Exposure of Veterans to Agent Orange and Other Herbicides Used in Vietnam Scientific Considerations Regarding a Request for Proposals for Research Committee on the Assessment of Wartime Exposure to Herbicides in Vietnam Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1997

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Characterizing Exposure of Veterans to Agent Orange and Other Herbicides Used in Vietnam: Scientific Considerations Regarding a Request for Proposals for Research NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this study was provided by the Department of Veterans Affairs (Contract No. V101(93)P-1331). The views, opinions, and/or findings contained in this report are those of the Committee on the Assessment of Wartime Exposure to Herbicides in Vietnam and should not be construed as an official Department of Veterans Affairs position, policy, or decision unless so designated by other documentation. International Standard Book Number 0-309-05731-0 Additional copies of this report are available for sale from: National Academy Press 2101 Constitution Avenue, N.W. Box 285 Washington, DC 20055 Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP's online bookstore at http://www.nap.edu/. Copyright 1997 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logo-type by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemusseen in Berlin.

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Characterizing Exposure of Veterans to Agent Orange and Other Herbicides Used in Vietnam: Scientific Considerations Regarding a Request for Proposals for Research COMMITTEE ON THE ASSESSMENT OF WARTIME EXPOSURE TO HERBICIDES IN VIETNAM DAVID G. HOEL* (Chair), Professor and Chairman, Department of Biometry and Epidemiology, and Associate Director for Epidemiology, Medical University of South Carolina S. KATHARINE HAMMOND, Associate Professor of Environmental Health Sciences and Director, Industrial Hygiene Program, School of Public Health, University of California at Berkeley LOREN D. KOLLER, Professor, College of Veterinary Medicine, Oregon State University DANA P. LOOMIS, Associate Professor, Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill STEPHEN M. RAPPAPORT, Professor of Occupational Health, Department of Environmental Sciences and Engineering, School of Public Health, University of North Carolina at Chapel Hill THOMAS J. SMITH, Professor of Industrial Hygiene and Director, Industrial Hygiene Program, Department of Environmental Health, Harvard School of Public Health DAVID J. TOLLERUD, Professor, Public Health and Medicine, and Chair, Center for Environmental and Occupational Health, School of Public Health, Allegheny University of the Health Sciences LAUREN ZEISE, Chief, Reproductive and Cancer Hazard Assessment Section, Office of Environmental Health and Hazard Assessment, California Environmental Protection Agency, Berkeley Staff DAVID A. BUTLER, Study Director SANJAY S. BALIGA, Research Associate (as of November 1996) DEBORAH KATZ, Research Associate (through August 1996) JAMES A. BOWERS, Project Assistant (as of November 1996) AMY NOEL O'HARA, Project Assistant (through August 1996) DONNA D. THOMPSON, Division Assistant SHARON L. GALLOWAY, Financial Associate KATHLEEN R. STRATTON, Director, Division of Health Promotion and Disease Prevention (as of January 1997) MICHAEL STOTO, Director, Division of Health Promotion and Disease Prevention (through December 1996) *   Member, Institute of Medicine.

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Characterizing Exposure of Veterans to Agent Orange and Other Herbicides Used in Vietnam: Scientific Considerations Regarding a Request for Proposals for Research Contents     INTRODUCTION   1     BACKGROUND   2     RFP STATEMENT OF WORK   3     SUPPLEMENTAL INFORMATION   3     BACKGROUND ON METHODS   5     Epidemiologic Study Designs   5     Past Exposure Assessment   6     AVAILABLE DATA   7     POTENTIAL APPROACHES   7     VALIDATION OF EXPOSURE ASSESSMENT APPROACHES   8     EVALUATION CRITERIA   8     Context   9     Technical Merit   9     Feasibility and Validation   10     Personnel and Experience   10     Cost and Timeline   10     RESEARCH PRODUCTS   10     REFERENCES   11 APPENDIX   The Assessment of Exposure to Herbicides Among Vietnam Veterans: A Review and Recommendations for Future Studies   12

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