Review of VA Clinical Guidance for the Health Conditions Identified by |
Committee on the Review of Clinical Guidance for the Care of Health Conditions
Identified by the Camp Lejeune Legislation
Board on the Health of Select Populations
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
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 competences and with regard for appropriate balance.
This study was supported by Contract/Grant No. VA241-P-2024 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
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International Standard Book Number-10: 978-0-309-31600-6
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Suggested citation: IOM (Institute of Medicine). 2015. Review of VA clinical guidance for the health conditions identified by the Camp Lejeune legislation. Washington, DC: The National Academies Press.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.
COMMITTEE ON THE REVIEW OF CLINICAL GUIDANCE FOR THE CARE OF
HEALTH CONDITIONS IDENTIFIED BY THE CAMP LEJEUNE LEGISLATION
DAVID R. NERENZ (Chair), Director of the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI
ROBERT J. ALPERN, Dean, Yale Medical School, New Haven, CT
PAOLO BOFFETTA, Director of the Institute for Translational Epidemiology and Associate Director for Population Sciences, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hospital, New York
MARY E. DAVIS, Professor, West Virginia University Health Sciences Center, Morgantown, WV
MICHAEL E. GOLDBERG, David Mahoney Professor of Brain and Behavior, Columbia University College of Physicians and Surgeons, New York
PAUL GRUNDY, Director of Healthcare Transformation, IBM, Hopewell Junction, NY
NANCY L. KEATING, Professor of Health Care Policy, Harvard Medical School, Boston, MA
PATRICIA JANULEWICZ LLOYD, Assistant Professor, Boston University School of Public Health, Boston, MA
GARY O. RANKIN, Professor and Chair, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV
MARK J. UTELL, Professor, University of Rochester School of Medicine, Rochester, NY
CAROL S. WOOD, Oak Ridge National Laboratory, Oak Ridge, TN
ALBERT W. WU, Professor and Director, Center for Health Services and Outcomes Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
IOM Staff
ROBERTA WEDGE, Study Director
CARY HAVER, Associate Program Officer
HEATHER CHIARELLO, Research Associate
ADRIANNA MOYA, Senior Program Assistant (through May 2014)
FREDRICK ERDTMANN, Director, Board on the Health of Select Populations
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Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
Peter F. Buckley, Georgia Regents University
Matthew Cave, University of Louisville
Evan D. Kharasch, Washington University in St. Louis
Francine Laden, Harvard School of Public Health
Bruce P. Lanphear, Simon Fraser University
Lawrence H. Lash, Wayne State University School of Medicine
Bruce S. McEwen, The Rockefeller University
Martin A. Philbert, University of Michigan
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Lynn R. Goldman, George Washington University School of Public Health and Health Sciences, and Kenneth W. Kizer, University of California, Davis, School of Medicine. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
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ADHD |
attention deficit hyperactivity disorder |
AFLD |
alcohol-related fatty liver disease |
ALS |
amyotrophic lateral sclerosis |
ATSDR |
Agency for Toxic Substances and Disease Registry |
CI |
confidence interval |
CKD |
chronic kidney disease |
CNS |
central nervous system |
CT |
computerized tomography |
CYP3A |
cytochrome P4503A |
DCE |
dichloroethylene |
DCVC |
dichlorovinylcysteine |
DCVCS |
dichlorovinylcysteine sulfoxide |
DCVG |
dichlorovinyl glutathione |
DCVT |
dichlorovinylthiol |
eGFR |
estimated glomerular filtration rate |
EPA |
U.S. Environmental Protection Agency |
ESRD |
end-stage renal disease |
FMO3 |
flavin monooxygenase 3 |
GAO |
Government Accountability Office |
GST |
glutathione S transferase |
HIV |
human immunodeficiency virus |
HR |
hazard ratio |
IARC |
International Agency for Research on Cancer |
IOM |
Institute of Medicine |
IRIS |
Integrated Risk Information System (of the EPA) |
KIM-1 |
kidney injury molecule-1 |
MCL |
maximum contaminant level |
MRI |
magnetic resonance imaging |
MS |
multiple sclerosis |
NAcDCVC |
N-acetyl dichlorovinylcysteine |
NAcDCVCS |
N-acetyl dichlorovinylcysteine sulfoxide |
NAcTCVC |
N-acetyl trichlorovinylcysteine |
NAcTCVCS |
N-acetyl trichlorovinylcysteine sulfoxide |
NAFLD |
non-alcoholic fatty liver disease |
NAG |
N-acetyl-β-D-glucosaminidase |
NAT |
N-acetyltransferase |
NIOSH |
National Institute for Occupational Safety and Health |
NMDA |
N-methyl-D-aspartic acid |
NRC |
National Research Council |
NTP |
National Toxicology Program |
OCD |
obsessive compulsive disorder |
OR |
odds ratio |
OSHA |
U.S. Occupational Safety and Health Administration |
PCE |
perchloroethylene (or tetrachloroethylene) |
Pi-GST |
Pi-glutathione S transferase |
PTSD |
posttraumatic stress disorder |
RR |
risk ratio |
SIR |
standardized incidence ratio |
SMR |
standardized mortality ratio |
TAFLD |
toxicant-associated fatty liver disease |
TCA |
trichloroacetic acid |
TCE |
trichloroethylene |
TCOH |
trichloroethanol |
TCVC |
trichlorovinylcysteine |
VA |
U.S. Department of Veterans Affairs |
VHA |
Veterans Health Administration (VA’s health care system) |
γGTP |
γ-glutamyltranspeptidase |