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                    <text>ItoimDNunber

0181

Author

Young, Alvin L.

°

Corporate Author
Rmnrt/Artidfl Titln Letter: from Alvin L. Young to Raymond Suskind,
nqiui i/m uuu
Febmary 23 1984

Journal/Book Title
Year

000

°

Month/Day
Color

n

Number of hianos

1

DeSCrlUton Notes

Alvin L. Young filed this item under "Vietnam Veterans
Twin Study." Enclosures mentioned in the letter are
missing.

Wednesday, July 11, 2001

Page 1811 of 1870

�EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF SCIENCE AND TECHNOLOGY POLICY
WASHINGTON. O.C. 20600

February 23, 1984

Dear Ray:
Thank you for the special hospitality shown to me during my
February 1, 1984 visit to the Institute. I hope your students
and staff enjoyed the exchange as much as I did.
As a follow-up to our conversation, I have enclosed some
documents that will be of interest to you.
c

0
0
0
0

Abbreviated package on the results of the Air Force Health
Study (RANCH HAND Epdemiologic Study). I presume that
George Lathrop will be sending you a copy of the technical
report.
CDC Protocol for Health Studies of Vietnam Veterans.
A 1969 Technical Report on Use of Herbicides in Southeast
Asia.
OSTP Cancer Document.
NTP Cancer Document.

The latter two documents on carcinogenesis are in the final
review stages and, at least in the case of the OSTP document,
will be submitted to the FEDERAL REGISTER in order to solicit
public comment.
Since my visit with you, I have had the opportunity to discuss
with Seth Eisen your continued interests and concerns in the
conduct of the Twin Study. I have encouraged him to pay you
a visit in the near future.
Best wishes.

Alvin Young, Ph.D.
LT COL USAF
Senior Policy Analyst
for Life Sciences
Dr. Raymond Suskind
Director
Institute of Environmental Health
University of Cincinnati College
of Medicine
3223 Eden Avenue
Cincinnati, Ohio 45267

�</text>
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          <element elementId="48">
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°1805

Author
Corporate Author
Report/ArUde Title Typescript: Minutes, CSP#256, Protocol #1
Coordinating Group Meeting held by Telephone
Conference Call, January 5,1984

Journal/Book Title
Year

000

°

Month/Day
Color

[J

Number of Images

5

DOSCrlPtOD NOtBS

Avn

' ' L- Young filed this item under "Vietnam Veterans
Twin Study."

Wednesday, July 11, 2001

Page 1806 of 1870

�REFERENCE SUP
TO (Name or litlo-Mait roulini aymbalt

INITIALS-DATE

'•CSP //256, Consultant Oversight Group
Protocol til . - •
a
- Chief CSP - Miami
Staff Assistant, CSP ~ VACO
••VETS Project Staff - St. Louis
NAS -MFUA Staff w Washington, B.C.
«• Agent Orange Project Office Staff - WA., D.C.v^
Rose David son f Contract Officer - VACOl
*.
"
Piet Harris, Contract Officer - NAS
REASON FOR flBFERSNCE
LJA» HEQOESTED

LJron voun riuee

LJ NOTE AND RETURN

LJ COMMENTS

LJ IN FORMATION.

LJ pen CONVERSATION

I—I

I

LjSIONATURE

I NECESSARY ACTION

REMARKS

Attached are the minutes of the recent Coordinating
Group Meeting on CSP 0256, Protocol //I,

FROM

DATE

I IXZ

JACK GOLDBERG , Ph.D., /]/" . /
Study Epidemiologist, lotfes VA CSPCf 51K
VA FORM

Mnn*

MAY t«ao 3230

ttXlSTINO

1TOCK* Of VA

AUS «»vt, WIUL as used.

fonu »iw,

1/19/84
T6U. EXT.

^ w ^ s &gt; O i y j 0 &lt; ,v8J.t06.2M

�MINUTES

CSP #256, Protocol #1 Coordinating Group Meeting
held by Telephone Conference Call
01/05/84

Present:
William True, Jack Goldberg, Dennis Robinette
Minutes of the meeting held on November 29, 1983 were approved as read and will be
distributed to all parties.
I.

ACCOMPLISHMENTS TO DATE

A.

Communications with States
Virginia
Has sent two tapes containing raale/male twin pairs to NAS. A

formal

application now has to be filed with Virginia so that the twins identified can be contacted.
California
California

has

requested that NAS file a formal application to use

their twin register. The California Review Committee meets
month.

once

a

Dennis is filling out forms sent by California.

Texas
No new information regarding

the Texas

birth certificate

search.

Connecticut
Forms

have been submitted to the Connecticut review group. We are

awaiting approval.
New Yo rk

No new information regarding the computerization of the New York twin
register.

-1-

�B.

WORK AT NPRC

1.

Computer System
The abstraction screens for data entry

2.

are

nearly

completed.

Twin Search Procedures
The

process

of determining which Connecticut twins were in the

military is continuing.

This process

is

based

on

the

"name

only" strategy. Dennis indicated that the search for additional
temporary staff at NPRC is under way.
3.

NPRC Registry Search
The

NPRC

Registry

search will not be done using a GSA subcon-

tract as was described in the 11/19/83 coordinating

group

min-

utes. Dennis indicated that it will be cheaper for NAS to write
the computer matching programs than to have it done
contract.

under

sub-

Mr. Joe Griffin, Head of Computer Operations at NRPC

has agreed to provide Dennis with computer tapes of the. 10

mil-

lion Vietnam era veterans contained on the NPRC register.
C.

Subcontract Arrangements
No new subcontract arrangements have been made.

D.

Work on DMDC Files
No new work on the DMDC files has been performed.

E.

Zygosity/Morbidity Questionnaire Development
The zygosity/morbidity questinnaire has not
OMB.

Jack

yet

been

submitted

to

indicated that it would be submitted within the next few

weeks.
F.

Development of a Procedures Document for the NPRC Search
The

procedures

manual describing the abstraction process is nearing

completion.

-2-

�II.

AREAS OF SPECIAL ATTENTION

A.

Contract Between VA and NAS
The final contract between VA and NAS has not been signed.
counsel

has

indicated

that

NAS

legal

cannot maintain the twin register

after the conclusion of the VETS project.
twin

VA

If NAS would maintain

the

register, it would be in clear violation of the law, according

to the VA legal counsel.

Decnis indicated that he

is

not

stopping

work at NAS or NPRC; he believes that this matter can be resolved between the NAS and VA lawyers. However, Dennis stated that NAS
not

let

any

could

subcontracts until the final contract is signed.

This

means that NORC and the State of New York have not received a subcontract

from NAS.

NORC does not appear to be worried by this and is

continuing to provide assistance in the development
of

and

pretesting

the zygosity/morbidity survey. New York has not and will not be-

gin to computerize their twin register until

a subcontract

is

re-

ceived from NAS.
B.

Problems With Obtaining Social Security Numbers
Larry Hobson has been negotiating with the Social
stration

Security

Admini-

to obtain social security numbers for twins identified from

state twin registers. Bill has indicated that Hobson is having
difficulty

some

in getting the Social Security Administration to agree to

provide social security numbers. Hobson recognizes the importance of
obtaining
C.

Social Security cooperation and is working on the problem.

Quality Control in Abstraction and Data Entry
Dennis suggested that an informal system of quality control
to

monitor the abstraction and data entry process.

a system where the NAS supervisor at NPRC would
ter's

work

on

be used

Dennis described

review

an

abstrac-

an irregular basis during the course of the project.

Jack Goldberg objected to this plan noting

that

a more

formalized

system of quality control is necessary. Jack suggested that a random
sample of records be reabstracted during the
project.

Bill

entire

length

of

the

True suggested that this was a problem that might be

discussed at the upcoming Consultant Oversight Group meeting.

-3-

�III.

TASKS TO BE COMPLETED BY THE NEXT COORDINATING GROUP MEETING

A.

VA Tasks
1. The zygosity/morbidity survey should be submitted to OMB.
is
2.

continued from

the list

This

of tasks from the last meeting.

A request to VACO to obtain a BIRLS file of potential twin pairs,
This file will be constructed based on same last name, different
first name, same state of issuance of the social security number
and same date of birth.

3.

B.

Check with Larry Hobson to determine if any progress has
made with the Social Security Administration.

been

NAS Tasks
1. Determine the number of twin pairs on the Virginia tapes.
2.

Submit formal applications to all remaining
access to the state twin registers.

states

to obtain

3.

Develop a description of how NAS proposes to conduct the mortality study outlined in CS? #256, Protocol #2 (p. 129-133).

4.

The abstraction of military records at NPRC should begin.

5.

Complete the procedures document describing the NPRC search and
abstraction process.

6.

Develop

additional

information on the completeness of the DMDC

file compared to the Connecticut twin register.
IV.

NEXT IMPORTANT DATES

The

next coordinating

group meeting will be held in Washington, D.C. on

Wednesday, January 31, following trie

conclusion

of

the COG-1

meeting.

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&lt;p&gt;For more about this collection, &lt;a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a"&gt;view the Agent Orange Exhibit.&lt;/a&gt;&lt;/p&gt;</text>
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                    <text>Item ID Number

01804

Author
Corporate Author
Roport/Artldo TltlO Typescript: Report of Meeting, October 27, [1983]

Journal/Book Title
Year

000

°

Month/Day
Color

U

Number of Images

1

UOSCriptOll NotBS

^'v'n *-• ^oung filed this item under "Vietnam Veterans
Twin Study." Summary of the sequence of activities for
placing the study on contract.

Wednesday, July 11, 2001

Page 1805 of 1870

�REPORT OF MEETING
PERSONS
Supply,
Studies
Leavitt,

PRESENT: Ms. Rose D a v i d s o n ( O f f i c e of P r o c u r e m e n t and
VACO, 389 3125), Dr. James Hagens (Chief, Cooperative
P r o g r a m ) , Dr. Ping Huang (CSP, VACO), Drs. Eisen, True,
and Goldberg (VETS, St. Louis and H i n e s )

MEETING PURPOSE: To review the details for
p r o g r a m on c o n t r a c t .

p l a c i n g the VETS

DATE - O c t o b e r 27, 1873
The f o l l o w i n g s u m m a r i z e s t h e s e q u e n c e o f a c t i v i t i e s f o r p l a c i n g
the VETS on c o n t r a c t .
W£JE_K

' '

ACTIVITY

1

Y e l l o w F o l d e r - " Y e l l o w f o l d e r " p r e p a r e d and c i r c u l a t e d . The
y e l l o w f o l d e r c o n s i s t s o f t h e r e s p o n s e t o t h e "24
questions", the proposed c o n t r a c t work s t a t e m e n t , and a
statement from the ACMD/R&amp;D which supports the contract
request. The yellow folder requires approval from the
Research Service, the CMD, General Counsel, Deputy
A d m i n i s t r a t o r for Logistics, and the A d m i n i s t r a t o r .The
a p p r o v a l process t y p i c a l l y takes 3-4 weeks.

4

R e q u e s t for Proposals ( R F P ) - A f t e r a p p r o v a l of the y e l l o w
folder is o b t a i n e d , the RFP is announced in the Commerce
Business Daily (CBD). A p p r o x i m a t e l y 5 days elapse between
t h e . s u b m i s s i o n of the r e q u e s t to the CBD and its
publication. Fifteen days must elapse between publication
and a c t u a l l y p l a c i n g the c o n t r a c t "on the s t r e e t " .

7

C o n t r a c t Work S t a t e m e n t released to p o t e n t i a l bidders.
P o t e n t i a l b i d d e r s h a v e 45 d a y s in w h i c h to r e s p o n d .

10 Pre-bid c o n f e r e n c e c o n v e n e d b e t w e e n the VA and p o t e n t i a l
b i d d e r s to discuss the R F P .
14 B i d d e r s s u b m i t r e s p o n s e t o
submitted proposals begins.

RFP. Technical

a n a l y s i s of

17 T e c h n i c a l a n a l y s i s c o n c l u d e d . Cost a n a l y s i s p e r f o r m e d only
on the t e c h n i c a l l y a c c e p t a b l e p r o p o s a l s .
18 B i d d e r s w h o s e p r o p o s a l a r e a c c e p t a b l e o n b o t h a t e c h n i c a l
and cost basis are asked to s u b m i t a "best and f i n a l o f f e r " .
19 P r o p o s a l selected and c o n t r a c t s i g n e d .

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&lt;p&gt;For more about this collection, &lt;a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a"&gt;view the Agent Orange Exhibit.&lt;/a&gt;&lt;/p&gt;</text>
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              <elementText elementTextId="22992">
                <text>Vietnam Experience Twin Study</text>
              </elementText>
              <elementText elementTextId="22994">
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  <item itemId="3135" public="1" featured="0">
    <fileContainer>
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                    <text>Item ID Number

01803

Author

Jemison, Terry L.

Corporate Author
RflpQrt/APtidB Titto

VA Concludes

JOIirnal/BOOk Title

U.S. Medicine

Year

1983

Month/Day

September 15

Color

n

Number of Images

3

Twins Study Feasible

Alvin L. Young filed this item under "Vietnam Veterans
Twin Study." Duplicate copy is the entire issue of the
publication.

Wednesday, July 11, 2001

Page 1804 of 1870

�Gonorrhea Vaccine Not Protective
By Nancy Tomich

VOL 19, No. 18 SEPTEMBER 15, 1983

Medicine
An Independent National Newspaper for Physicians

WASHINGTON—Army researchers here
are beginning the detailed process of
determining why a vaccine developed to
protect against gonorrhea infection
worked so poorly.
The vaccine, tested earlier this year in
a field trial among U.S. military personnel stationed in Korea, "clearly was not
significantly protective," Col. Edmund
Tramont, MC, USA, of Walter Reed
Army Institute of Research, related.
Dr. Tramont .and his colleagues
brought back 30,000 specimens taken
from 3,252 volunteers and from other
military personnel who were seen by the
study team for comparison purposes.
These specimens, he said, have been
catalogued and filed and are ready to be
checked for antibody response levels.

Vietnam Data Sought

VA Concludes Twins Study Feasible
By Terry Jemison
WASHINGTON—Researchers planning
to compare sets of identical twins to
consider health effects of Vietnam service have concluded there are more than
enough pairs to get the study going and

have received approval to start finding
them.
If both twins were in the military but
only one brother served in Vietnam,
researchers hope to determine if there
are statistically significant differences
between the two that would suggest
health effects peculiar to the Vietnam
jungle and combat environment itself.
Though "Vietnam service" is the risk
factor of primary interest, agent orange
exposure and post-traumatic stress disorder experiences also will be examined.
Both dizygotic and monozygotic
(identical) twins would be involved in a
morbidity and mortality analysis, with a
five- to six-day battery of physical
examinations for a small subgroup of
the identical twins.

They are of particular interest to
researchers because they are genetically
identical and more likely to have shared
the same environment through the
(Continued on paf&gt;e 20)

Thoracic Surgeons' Report:
'Questions' At Wilford Hall
—U.S. Medicine photo
Dr. Seth Eisen, who will conduct the
twins study, found the universe of
potential subjects to be adequate.

DoD Develops
Standardized
THC Cut-Off
By Judy E. Fox
WASHINGTON—Standardi/ed minimum requirements for confirming urine
samples which previously tested positive for the presence of marijuana
are being developed by the Department
of Defense for use by all three military
services.
The requirements arc another step in
the DoD effort to standardize the military's Hrna 'ihuc^ *r...«;~~ - -

WASHINGTON -A report issued by the
Society of Thoracic Surgeons concludes
there were some procedures performed
by a cardiac surgeon at Wilford Hall Air
Force Medical Center in which his technique was "questionable."
The report was prepared by the
society under contract to the Air Force
in an attempt to elucidate the situation
at Wilford Hall during a time when Dr.
William Stanford, then chief of cardiothoracic surgery, was criticized by some
staff members as being "rough" in his
surgical techniques. The staff members
also charged that Dr. Stanford's patient
mortality rate was excessively high and
his graft patency rate excessively low.

In addition, 1,000 organism specimens must be tested for antigcnic
variations.
The raw data, however, leave no
doubt that the vaccine, as it currently is
configured and administered, "is not
protective enough to go to the field,"
Dr. Tramont said.
There earlier had been some concern
that statistically significant results
could not be obtained because the trial's
volunteer rate was not as high as
researchers had hoped (it was only 64
per cent of the level envisioned in the
protocol). However, the raw data so
clearly indicate the vaccine did not
confer sufficient protection that those
concerns do not come into play any
more, another source said.
"Where we go from here will depend
on what the antibody results tell us,"
Dr. Tramont related.
There are several possible explanations for the vaccine's failure to confer
protection that have to be examined, he
said.
One is whether the vaccine produced
an antibody response that in fact should
have been protective. If it did, and if
studies show exposure was to the correct serotype, then there may be something wrong with the theory behind the
vaccine itself.
The vaccine, developed jointly by
researchers at WRAIR and the University of Pittsburgh, is the first one aimed
at a local infection.
If the antibody response is low, however, then there must be something
(Continued on page 11)

The carefully worded Thoracic Surgeons report, obtained by U.S. MEDICINE through a Freedom of Information
Act request, says for certain procedures
Dr. Stanford's mortality rate and
results appear "questionable." For others, however, Dr. Stanford's results
were acceptable, it states.
The report was submitted by the
Society of Thoracic Surgeons to the Air
Force in April. In July a supplement to
the report, responding to questions
raised by the Air Force inspector, general about the original report, also was
submitted.
A special committee was appointed
(Continued on page 18)

Neisseria gonorrhea

Air Controller Stress Criteria Urged
WASHINGTON--'!^ Federal Aviation
Administration, which closed several of

the agency is how it can place more

Yet the agency has cut the number of

�U.S. MEDIQ

20

VA Will Study Twins
For Vietnam 'Effects'
(Continued from page 1)

developmental years than other pairs of
individuals.
Primary investigator Dr. Seth Eisen
of the St. Louis VA hospital, announcing the results of a feasibility analysis
conducted to see if the study could be
done, determined there are probably
17,000 twin pairs in the country that
meet the criteria of military service with
one a Vietnam veteran and the other
not.
He and his associates concluded that
about half of the pairs are mono/ygotic,
and suitable for the "intensive health
assessment" phase of physical examinations.
Dr. Eisen, briefing VA agent orange
advisors, said his team and collaborators at the Hines, 111., VA hospital cooperative: studies program have received
approval to begin identifying twins.
A formal protocol has not been finished, but the study hopefully will begin
next year, he said. The health assessments could take 18 months, with data
analysis requiring an additional six to
12 months, he predicted.
Dr. Eisen said investigators will not
limit their interest to the pairs where one
served in Vietnam while the other
brother served at a stateside base,
because the statistical power will be
enhanced by comparing two other
groups: Vietnam veterans compared to
brothers who also saw Vietnam service
as well as pairs where both brothers
were in the military but neither served in
Vietnam.
For example, if the researchers find
that in the "non-Vietnam/Vietnam set"
the Vietnam veterans have four times
the risk of diabetes as their brothers, the
fourfold risk elevation should similarly
be reflected in both subjects throughout
the Vietnam/Vietnam set while the rate
of diabetes should be noticeably low in
the both subjects of each non-Vietnam/
non-Vietnam set.
Such tripartite analyses should offer
"powerful support of the non-Vietnam/
Vietnam twin pair findings," Dr. Eisen
said.
While about 10,000 pairs would be
used in the morbidity and mortality
analysis, only 500 pairs would undergo
the intensive physical examination
phase, he told members of the V A advisory committee on agent orange.
One of the advisors, Dr. Marion
Moses of Johns Hopkins University,

voiced concern about the ability to compare twins with important differences —
for example if one is a heavy smoker
and the other is not.
Dr. Richard A. Hodder of the Walter
Reed Army Institute of Research added
that one of the twins may have a "profile" of characteristics that kept him
from Vietnam service.
Dr. Eisen said the life history prior to
induction will be reviewed, but investigators hope "to minimize exclusion
criteria" for study subjects.
State birth certificates will be
reviewed to find twin pairs, who will be
traced to determine if they had military
experience. Upon determination of the
Vietnam experience, they will be
assigned to appropriate subgroups.
Dr. Eisen's announcement that
researchers had determined that an adequate universe of potential subjects
exists to continue the efforts was based
on epidemiologic analysis of the birth
years from 1939 to 1953.
During that time, 25 million males
were bora, and the epidemiologic data
suggest that includes 400,000 twins —
half monozygotic and half dizygotic. In
about half of the pairs, neither brother
will have had military service.
Of about 46,000 twin pairs who both
had military service —the first study
criterion —initial indications arc that
for 26 per cent, neither served in Vietnam; in 37 per cent of the cases, one did;
for 23 per cent, both did; and for 14 per
cent, that has not been determined.
He said the twins study is a good
opportunity for VA to conduct research
that the public will accept because the
hypothesis is simple and the idea of
comparing twins is interesting.
VA was pressured to give up its major
epidemiological study of ground troops
thought exposed to agent orange ostensibly because of congressional concern
about the bclicvability of research sponsored by the VA, which could face millions of dollars of compensation costs if
scientists advise policymakers there is a
link between diseases and service.
In other agent orange developments,
the week the advisors met, the American Chemical Society was told that a
registry of veterans who have undergone special VA agent orange examinations does not support the thesis there is
unusual long-term morbidity associated
with Vietnam service or agent orange
exposure.

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FAA Examines CAM

By Judy E. Fox
WASHINGTON- There are strong indications that the research branch of the
:~^»,\;^i Tnctitiif fr AMI1 will be

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Data presented at chemical association meeting show number and per cent
distribution of selected malignant neoplasm cases among 84,456 veterans recorded
in the Agent Orange Registry and comparison to a reference population.
However, the registry is composed of
In fact, he noted, THE NEW YORK
self-referred veterans who have pre- TIMES story on the chemical society data
sented at VA hospitals concerned about reported that Dr. Young had said that
yTe health effects of agent orange.
his report on the registry, which it called
/ A senior researcher for the VA mcdi- a study, was not a true epidcmiologic
fcai department's agent orange program study.
:
office, Dr. Alvin L. Young, presented
In the paper, "Evaluation of Veterans
data from the registry, which involves for Agent Orange Exposure," coaumore than 110,000 veterans examined thored by M. R. Flicker, Dr. Young
by VA physicians. He described the reported that only three-fourths of the
analysis of data now complete for 85,000 veterans complained of symp85,000 cases.
toms, most frequently dermatologic
Following media coverage of the and psychologic.
data, the American Legion circulated a
Other symptoms reported in at least
news release criticizing Dr. Young's 10 per cent of registered patients were
statements as "totally irresponsible and headaches, peripheral neuropathy,
misleading."
asthenia and gastrointestinal disorder.
The Legion criticized Dr. Young
The majority of symptoms, the paper
because "he apparently did not clarify reported, "bear no correlation to the
that his conclusions were not based on known toxicology of herbicide orange;
any study per sc."
in addition, no increased incidence of
Dr. Young categorically denied the malignancy (has) been observed in this
charge in the Legion's press release. "I population, which, by virtue of its selfclearly staled this was surveillance of selected nature, may have been expected
veterans who were a self-selected group to exhibit artificially higher than baseof men," he told U.S. MEDICINE.
line rates in the general population."

II Research Branch
But, he asserted, the committee did not recommend one of the three over the
others—that decision will be made by FAA administrator Helms.
"The team was unable to come up with a consensus as to which alternative to
choose but we all agreed that any of the three would be better than the way it is
run now," Smith emphasized.
Another FAA source expressed his concern that if medical research becomes

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Report/Article Title Researchers Say Stress Affects Immune System

JOUIUll/BOOk Title

The

Year

1983

Month/Day

June27

Color

n

Number of Imaaes

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DeSCrlptOR Notes

Alvin L Youn

Washington Post

9filed this item under 'Vietnam Veterans
Twin Study."

Wednesday, July 11, 2001

Page 1798 of 1870

�:A8

Monday, Junn 27, IVXi

THE WASHINGTON POST

Researchers Say Stress Affects Immune System
By John Wflke

• Washington Peel Staff Writer

A Harvard Medical School team reports it
has found evidence linking stress and the
body's ability to fight disease.
Researchers at Harvard, Tufts University
and Beth Israel Hospital in Boston found a systematic drop in the immune system effectiveness of dental students when they were under
considerable stress during a year-long study.
Their results were published in Saturday's
issue of The Lancet, a British medical journal.
"The study substantiates the theory that
stress affects the human immune system," said
Dr. John B. Jemmott, co-author of the report.
This relationship has been shown inanimate,
but earlier human studies had been less conclusive, he said.
Personality was identified as a significant
factor in how an individual's immune system

responds to stress, the researchers said, suggesting that people who cope better with job, school
and emotional challenges are less likely to show
lowered levels of a substance that is important
to the body's ability to ward off illness.
Levels of immunoglobulin-A (IGA), an antibody found in human secretions, rose and fell
relative to the degree of stress the students experienced during major exams, the researchers
reported. In the mouth, immunoglobulin-A
fights viruses and bacteria that can cause tooth
decay, colds, bronchitis and other respiratorytract diseases.
The subjects, 48 men and 16 women, were
first-year students in a demanding dental surgery program.
Levels of IGA were tested in saliva samples
five times during the school year: in September
before classes began; in November, April and
June during intensive examination weeks, and
in July .during summer recess.

All subjects showed lower levels of-IGA during exams than at the start-of the year, the
study found. Also, individuals found by standardized personality tests to be competitive
tended to show lower levels of IGA than their
less competitive colleagues.
"Not only does stress affect one's ability to
fight disease, but how one interprets the stressful situation, as determined by one's personality, is also important," said Dr. Herbert Benson,
chief of Beth Israel's department of behavioral
medicine. "What stresses one person may not
stress another," he said.
Two earlier studies suggested the possibility
of immune-system malfunction under stress by
comparing the infection-fighting capability of
• white blood cells taken from normal and severely stressed subjects. The test subjects included
persons whose spouses had died recently and
astronauts in the Skylab space program.

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&lt;p&gt;For more about this collection, &lt;a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a"&gt;view the Agent Orange Exhibit.&lt;/a&gt;&lt;/p&gt;</text>
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01796

Author
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ROpOTt/ArtiCto TitlO Typescript: Proposal - Protocol II, June 17, 1983

Journal/Book Titto
Yoar

000

°

Month/Day
Color
Number of bnages
DOSOrlptOR NOtBS

n

7

Alvin L Youn

9filed this itern under "Vietnam Veterans
Twin Study." Provides proposed screening tests of
hepatic function and references.

Wednesday, July 11, 2001

Page 1797 of 1870

�PROPOSAL - PROTOCOL II
PROPOSED SCREENING TESTS OF HEPATIC FUNCTION (modified from 3)
TEST

DETECTS HEPATIC
ABNORMALITY

Bilirubin

Biliary obstruction

No

No

Standard test for biliary obstruction,
specificity increased through use of
other tests

Alkaline Phosphatase

Biliary obstruction
Infiltrative disease

Yes

No

Very sensitive test, specificity
increased through use of other tests

SCOT

Hepatocellular necrosis

Yes

No

Sensitive test, specificity increased
through use of other tests

SGPT

Hepatocelluiar necrosis

Yes

Yes

Test is both sensitive and specific

GTTP

Biliary obstruction
Hepatoceliular necrosis
Ethanol ingestion

Yes

No

Helps distinguish hepatic from nonhepatic origin of alkaline phosphatase;
one of the most sensitive indicators
of chronic alcohol ingestion

Cirrhosis
Hepatocelluiar necrosis

No

No

Helpful in detecting more severe
degrees of hepatic damage

Hepatitis Associated
Antigens &amp; Antibodies

Viral hepatitis

Yes

Yes

Excellent tests for understanding
hepatitis infection history

Aminopyrine Breath Test

Microsome induction

No

No

Quantitates microsornal function

Serum Bile Acids

Biliary obstruction
Hepatocelluiar "necrosis

Yes

Yes

Sensitive and specific test

Porphyrins

Porphyuria

Yes

Yes

Sensitive and specific test

Serum Albumin &amp; Globulin

6/17/83

1

SENSITIVITY

122

SPECIFICITY

RATIONALE FOR UTILIZATION

FOR OFFICIAL USE ONLY

�PROPOSAL - PROTOCOL II
VIII. REFERENCES

(Mary Anne)

Aim, R., Carlson, 3., Eriksson, S. Fasting serum bile acids in liver disease. Sjcajodinavian
7j 213-218.
Anonymous. Serum bile acids in hepatobiliary disease. £h£jyinoet. 1982; II: 1136-1138.
Arito, H., Sudo, A., Hara, N. Nakagaki, K., Torii, S. Changes in circadian sleep-waking
thythrns of rats following administration of methylrnercury chloride. |nd Health; 1982j 20:
55-65.
Barnett, A.M., Leslie R.D.G., Pyke, D.A. Twin studies in non-insulin dependent diabetes. In:
The Genetic of Diabetes Mellitus, Kobberling, K., Tattersall, R. eds., p. 225; Academic
Press, New York, 1981.
Bennett, P. H. The epidemiology of diabetes mellitus. In: Diabetes Mellitus, Volume V,
Rifkin, H., Raskin, P. eds. p. 87, Prentice-Hall, Bowie, Maryland, 1981.
Berger, R., Bernheim, A., Mitelman, F., Rydholm, A. C-band pattern in lympocytes of
patients with soft tissue sarcomas. Cance^Genjeticj^an^Cj^t^ejriej^cs; 1983; 9; 1*5-150.
Blackburn, A.B. Review of the effects of Agent Orange: A psychiatric perspective on the
controversy. Mi^arj^J^icine; 1983; 1*8: 333-3*0.
Bogen, G. Symptoms in Vietnam veterans exposed to Agent Orange. JAMA; 1979; 2*2;
2391.
Buckingham, Jr. W.A.; Operation Ranch Hand. The Air Force and Herbicides in Southeast
Asia, 1961-1971. Office of Air Force History, United States Air Force, Washington, D. C.,
1982.
Buffler, P. A., Aase, 3M. Genetic risks and environmental surveillance: Epidemiological
aspects of monitoring industrial populations for environmental mutagens. J_Occu£a Me_d;
1982; 2*? 305-31*.
" ...... ~
Burgdorf, W., Kurvink, K., Cervcnka, 3. Elevated sister chrornatid exchange rate* in
lymphocytes of subjects treated with arsenic. Humari G_enet|cs; 1977; 3j6; 69-72.
liurnstein, A.V., Galambos, ."J.T. (1*C) Aminopyrine breath test in chronic liver disease.
Preliminary diagnostic implications. Dig^tjve_pj.se^e^_anfl_^_ieiices. 1981; 26; 1078-1083.
Clombi, A., Maroni, M., Ferioli, A., Valla, C., Colleti, G., Foa, V. Liquid chromatography of
urinary porphyrins for the bilogical monitoring of occupational exposure to porphyrinogenic
substances. A.Q].encj^]iJ(pjjrnaj._pf In^sl^ial_ Medicine. 1983; *; 551-56*.
Courtney, K.D., Gaylor, D.W., Hogan, M.D., Falk, H.L., Bates R.R., Mitchell, I. Teratogenic
evaluation of 2,*,5-T. Science 1970; 168: 86*~366.

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142

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�PROPOSAL - PROTOCOL II
Crossen, P.E., Morgan, W.F., Horan, 3.3., Stewart, 3. Cytogenetic studies of pesticide and
herbicide sprayers. NjewJ^JandJMe^^
1978; 88; 192-195.
Culliton, B.3. CDC finds no excess illness at Love Canal. Scierjce; 1983; 220; 1254.
Dabney, 6.3. The role of human genetic monitoring in the workplace. A!2.3_pccu£ational
icin^ 23; 1981; 625-631.
Doss, M.O. Hepatic Porphyrias: Pathobiochemical, diagnostic, and therapeutic
implications. Pj^gressjin_ Liver PJseases. 1982; 7; 573-?.
Dossing, M. Changes in hepatic microsomal enzyme function in workers exposed to mixtures
of chemicals. CJinical .Ph§IJ^.99]oSy^fi^TJl?I^P^,!^iS.s.' 1982; 32; 340-346.
Douglas, 3. G., Beckett, G. 3., Nirnmo, I. A., Finlayson, N.D.C., Percy-Robb, I.W. Clinical
value of bile salt tests in anicteric liver disease. Got. 1981; 22; 141-148.
Drill, V.A., Hiratzka, T. Toxicity of 2,4-dichlorophenoxyacetic acid. Ar^l&gt;lnjdjjstria.l
*PjL9j^
1953;£: 61-67.
Evans, H. 3., O'Reordan, M. L. Human peripheral blood lymphocytes for the analysis of
chromosomal aberrations in rnutagen tests. J^taJJl£S, 1975; _3 1:1 35-1 48.
Fabricant, 3.D., Legator, M.S. Etiology, role and detection of chromosomal aberrations in
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Feinberg, M. Gillin, 3.C., Carroll, B.3., Greden, 3.F., Zis, A.P. EEC studies of sleep in the
diagnosis of depression. B^og^^jPjy_cJ}iatrj/;;1982; 17: 305-315.
Frye, 3.S., Stockton, R.A. Discriminant analysis of posttraumatic stress disorder among
group of Viet Nam veterans. AjruJ_Pj^jTiatry_j 1982; J.39: 52-56.
Galizzi, 3., Morgan, M.Y., Chitranukroh, A., Sherlock, S. The detection of minimal alcoholic
liver disease by three methods. Scandinavian journal of_ Gas_trojenterqlogy_. 1978; 13; 827831.
'^
Gillin, 3.C. Sleep studies in affective illness: diagnostic, therapeutic, and
pathophysiological implications. Psyjchia.tric_Annals; 1983; 1_3: 367-384.
Guilleminault, C., Dement, W.C. Sleep apnea syndromes. Liss, New York, 1978.
Gradwohl's Clinical Laboratory Methods and Diagnosis. Sonnenwirth, A.C., 3arett, L, ed.
St. Louis, C.V. Mosby Company, 1980.
Guilleminault, C» (ed) Sleeping and waking disorders: indications and technique. AddisonWesley, Menlo Park, CA, 1982.

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143

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�PROPOSAL - PROTOCOL II
Guzelian, P.S. Research needs for hepatic injury due to environmental agents.
]|Q!£k2l}?^
19835 48; 65-71.
Hammond, R. 1979 National survey of veterans. Summary report. Reports and Statistics
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Clinical Diagnosis and Management by Laboratory Methods. Henry, 3.B., ed. Philadelphia,
W.W. Saunders Company, 1979.
Hepner, G. W., Vesell, E.S. Quantitative assessment of hepatic function by breath analysis
after oral administration of (l^C) aminopyrine. Annals of Internal Medicine. 1975; 83; 632638.
Hoofnagle, 3.H. Serodiagnosis of acute viral hepatitis. Itepatplqgy. 1983; _3; 267-268.
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breath test as a measure of liver function. 3ournal o|_ Laboratory and_Clinical_Mjedicine.
1 982; 100; 356-?.
........
" " ............. " "
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rnonozygotic twins. Human Heredity; 1971; 2J; 557-576.
Koella, W.P. Neurotransmitters and sleep. In: Wheatley, D. (ed). Psychopharmacology of
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Kader, G.A., Griffin, P.T. Reevaluation of the phenomena of the first night effect. Sleep;
1983; 6: 67-71.
Kupfer, D.3., Targ, E., Stack, 3, Electroencephalographic sleep in unipolar depressive
subtypes. 3_Ner^o^s^jr|d^enj^p|se^se; 1982; J70: 494-498.
Leslie, R.D.G., Pyke, D.A. Diabetic retinopathy in identical twins. Diabetes;' 1982; 31: 1921.
McCarley, R.W. REM sleep and depression: common neurobiological control mechanisms.
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Monroe, P.S., Baker, A.L., Schneider, 3.F., Krager, P.S,, Klein, P.D., Schoeller, D. The
aminopyrine breath test and serum bile acids reflect histologic severity in chronic hepatitis.
HapatotogXi 1982; 2; 317-322.
Monteleone, P, Personal Communication, 1983. One chromosomal aberration per 10 cells is
the standard for the cytogenetic laboratory at St. Louis University School of Medicine.

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144

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�PROPOSAL - PROTOCOL II
Montz, S.W., Card, W.C., Kirkpatrick, R.L. Effects of polychiorinated biphenyis and
nutritional restriction on barbituate-induced sleeping times and selected blood
characteristics in raccoons. Bull Environ Contam _and_Tox; 1982; 28: 578.
National Diabetes Data Group. Classification and diagnosis of diabetes rnellitus and other
categories of glucose intolerance. Hiabetes; 1979; 28; 1039-1057.
Reggiani, G. Medical survey techniques in the Seveso TCDD exposure.
Rickers, H., Christensen, M., Arrif red T., Dige, U n Hess Thaysen. The diagnostic value of
fasting serum total bile acid concentration in patients with suspected liver disease.
1982; J7; 565-570.
Rowe, V.K., Hyrnans, T.A. Summary of toxicological information of 2,4~D and 2,4, 5-T type
herbicides and an evaluation of the hazards to livestock associated with their use. American
3_Vet_Res; 1954; 1_5: 622-629.
Sandberg, A. A., ed. Sister Chromatid Exchange, Alan R. Liss, Inc., New York, 1982.
Saunders, J.B., Lewis, K.O., Paton, A. Early diagnosis of alcoholic cirrhosis by the
aminopyrine breath test. GajJ^ejiterolojgy. 1980} 79; 112-114.
Schmidt, H.S., Kaelbling, R. The differential laboratory adaptation of sleep parameters.
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Sotaniemi, E.A., Sutinen, 5., Arranto, A.J., Olavi Pelkonen, O. Liver injury in subjects
occupationally exposed to chemicals in low doses. Acta _Medica Scand 1982; 212; 207-215.
Chemical Porpyria in Man. Strik, 3JTWA, Koeman, J.H., eds. New York, Elsevier/North
Holland Btomedical Press, 1979.
.
' *
Taylor, C.C. Chemical toxicity and mental disorder. American journal of .Psyjchiatry; 1974;
131: 609-?.
9.

Uppai, R.P., Garg, B.D., Ahmad, A. Effect of malathion and DDT on response of mice to
pentobarbitone. IndJIJ|xpjBiol; 1982; 20s 628-629.
Vainio, H., Sorsa, M. Application of cytogerietic methods for biological monitoring. Annual
lth; 1983; 4; 403-407.

6/17/83

145

FOR OFFICIAL USE ONLY

�PROPOSAL - PROTOCOL 51
Waksvik, H., Magnus, P., Burg, K. Effects of age, sex and genes on sister chromatid
exchange. Clinical__Geneti_cs; 1981; 20; 449-454.
Walsh ref 5
Walsh ref 6
Walsh ref 7
Walsh ref 8
Walsh ref 9
Walsh ref 24
Walsh ref 25
Walsh ref 26
Walsh ref 22
Walsh ref 1
Walsh ref 2
Walsh ref 10
Walsh ref 11
Walsh ref 12
Walsh ref 13
Walsh ref 15
Walsh ref 14

.

"

Walsh ref 18
Walsh ref 19
Webb, W.B., Campbell, S.S. Hereditary aspects of sleep structure and length: twin
correlations. Sleep.Research; 1982; ?:102-?.
West, K.M. Diabetes; 1975; 24: 461-

.

Wilmer, H.A. Post-traumatic stress disorder. j^J^hi§Jtn£^nnalsj 1982; 12: 995-1003.

6/17/83

146

FOR OFFICIAL USE ONLY

�PROPOSAL - PROTOCOL II
Wolff, S. Problems and prospects in the utilization of cytogenetics to estimate exposure at
toxic chemical waste dumps. E^yirj^menj^J
1983; ft8; 23-27.
Zapato-Gayon, C., Zapato-Gayon, N., Gonzalez-Angulo, A. Clastogenic chromosomal
aberrations in 26 individuals accidently exposed to ortho dichlorobenzene vapors in the
National Medical Center in Mexico City. Archives_of Environment Health; 1982; 37; 231235.
Zung, W.W.K., Wilson, W.P. Sleep and dream patterns in twins: Markov analysis of a
genetic trait. In: ?

6/17/83

147

FOR OFFICIAL USE ONLY

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                  <text>&lt;p style="margin-top: -1em; line-height: 1.2em;"&gt;The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.&lt;/p&gt;&#13;
&lt;p&gt;For more about this collection, &lt;a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a"&gt;view the Agent Orange Exhibit.&lt;/a&gt;&lt;/p&gt;</text>
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                <text>Typescript: Proposal - Protocol II, June 17, 1983</text>
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                <text>Vietnam Experience Twin Study</text>
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                <text>study protocol</text>
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                    <text>Item ID Number

01792

Author
Corporate Author
RODOrt/ArtidO TitlO Typescript: VETS Draft, Physical Examination, March
29,1983

Journal/Book Title
Yoar

Color
Number of Images

DOSCrlptOn NOtOS

000

°

n

4

Alvin L Youn

9 filed this item under "Vietnam Veterans
Twin Study."

Wednesday, July 11, 2001

Page 1793 of 1870

�/FT?, - D R A F T 3 / ?. 9 / 8 3 - FOR O F F I C I A L USE

ONLY

INTRODUCT10N
The
physical
eK^m
is
designed
tu
provide
;•.
o own i eli ens i v e
A s s e s s m e n t of t h e p a r t i c i p a n t ' s p a s t and p r e s e n t s t a I t&gt; of
h£a I i h
&lt;\nd
to
obtain
in d e p t h i n f e r ma t i o n A b o u t
certain
&lt;. s&gt; p *_• o t s
ot
h e a l t h which m i g h t b e p a r t i c u l a r l y r e l e v a n t f o r e v a l u a t i o n
the
effects
of
the
Vietnam experience.
To h e l p
ensure
that
t; i e
ax ami n a t i o n is p e r f o r m e d as o b i e c t i v e i . y as p o s s i b l e , t h e t K um i rt a r
will
n o t know t h e m i l i t a r y e x p e r i e n c e o f t h e i n d i v i d u a l sIho
i3
examining.
By
combining i n f o r m a t i o n o b t a i n e d from the
physic.-,!
e a a ia
with
questionnaire,
psychologic.
physioloyic,
and
biochemical data,
the s t a t e of h e a l t h &gt;&gt; t t h e p a r t i c i p a n t s j. t one
p o i n t in t i m e w i l l be c a r e f u l l y d o c u m e n t e d .
T w o b o a r d c e r t i f i e d i n t e r n i s t s w i l l p e r f o r m t h e f e warns.
The
same
physician will
e x a m i n e b o t h m e m b e r s of a t w i n p a i r .
To
assess
q u a l i t y and c o n s i s t a n c y , at l e a s t w e e k l y , a u a i d n o n - t w i n w i l l hee x a m i n e d by each p h y s i c i a n t w i c e ,
j u s t as i f t h e phy s i o i &lt;-. ns w e r e
e x a m i n i n g t w i n p a i r s . G e n e r a l l y , t h e e x a m i n i n g p h y s i c i a n s w i l l beu n a b l e to d i s t i n g u i s h the real from "placebo" twins.
The r n s u i t s
of
t h e e x a m i n a t i o n s w i l l then b e c o m p a r e d f o r i n t r a
and
interphysician reliability.
Occasionally,
t h e " p l a c e b o twin" w i l l b e
specifically
chosen b e c a u s e o f a known a b n o r m a l i t y &lt; f o r e x a m p l e ,
a slightly enlarged liver,
heart,
c e r t a i n sic i n
lesions.
etc),
A g a i n , c o n s i s t a n c y among exams w i l l b e asses&amp;ed.

S P E C I F I C GOALS OF THE PHYSICAL EXAMINATION

T h e f o l l o w i n g is a l i s t o f s p e c i f i c r e s e a r c h h y p o t h e s e s w h i c h t h e
physical
e x a m i n a t i o n i s d « s i g n e d to a d d r e s s ,
and t h e
rationale
f o r a d d r e s s i n g t h e m . Many a d d i t i o n a l h y p o t h e s e s oan b e n e n e g a t e d .
However,
only
those w h i c h are most i m p o r t a n t to the.- p u r p o s e s of
the
VETS
are included below.
It should be understood t h a t
any
physical
d i f f e r e n c e s which a r e d e f i n e d w i l l b e
correlated with
o t h e r d a t a o b t a i n e d from the comprehensive h e a l t h e v a l u a t i o n . If
possible,
s p e c i f i o d i a g n o s e s w i l l then be m a d e and an
etiology
for t h e i l l n e s s e s e s t a b l i s h e d .
S e c t i o n c of e a c h h y p o t h e s i s is &lt;i
list
of s p e c i f i c portions of the physical examination which w i l l
be
utilized
to
evaluate
the
hypothesis.
The
numbers
in
[&gt;•, r e n t h e s e s
refer
to
the r e l e v a n t
sections
in
the
physical
e x a m i n a t i o n form.

a.

b.
tha

Hypothesis
- Th e d e r ma t o 1 o g t c assess we n I of t h e
V i e t n r.
d p a r t i c i p a n t is not d i f f e r e n t f r o m t h a t of hi. s t w i n .

Rationale
- De rma t o ! o g i c I e s i o 7 i s d i r e c t l y a t t r i b u t a b l e to
Vietnam
experience
are most l i k e l y
to
be
dsrived
from:

�VETS - DRAFT 3 / 2 9 / 8 3

- FOR O F F I C I A L

USE ONLY

residual
scarring
as a consequence of skin i n f e c t i o n s w h i l e
Vietnam
and/or
active
or residual
chloracne.
Reports
of
increased
incidence
i n sk:in i n f e c t i o n s s u b s e q u e n t t o
be.ing
V i e t , natti can a l s o be e v a l u a t e d .
c

S e c t i o n s of

in
an
in

t h e p h y s i c a l exam w h i c h a d r f i e s s t h e h y p o t h e s i s

identification
of
skin lasions,
present; e
p i gme n t a t i o n p a t t e r n s , a l o p e c i a , h i r s u i t i s m

of

f u l l face a n d b i l a t e r a l p r o f i l e photographs,
of s k i n l e s i o n s

abaoriL.j.1

photographs

2
a . H y p o t h e s i s - The V i. e t n am e x p e r i e n c e d p a r t i c i p a n t ' s h e p a t i c
f u n c t i o n is n o d i f f e r e n t f r o m t h a t of h i s t w i n .
b.
R a t i o n a l e - The l i v e r may b&lt;± a f f e c t e d by e x p o s u r e to
&lt;\ny
one of j, v a r i e t y of t o x i c s u b s t a n c e s and in f a c t i o u s a g e n t s w h i c h
were p r e s e n t in V i e t n a m .
S e c t i o n s of

the p h y s i c a l e«;;io w h i c h a d d r e s s

the h y p o t h e s i s

liver
and
spleen size (by p a l p a t i o n
and
percussion),
g y n e e o m a s t i a , a s c i t e s , edema , s p i d e r ;.vng i oma t a
a.
Hypothesis
- The
Vietnam
experienced
participant's
neurologic function is not d i f f e r e n t from that of his twin.
b.
R a t i o n a l e - Vietnam experienced veterans report a v a r i e t y
of
neuro1ogica11y
r e l a t e d symptoms and animal and
human
data
s u g g e s t s t h a t e x p o s u r e t o A g e n t O r g a n e may a f f e c t the
neurologic
system
adversely.
A
c a r e f u l assessment o f
current
neurologic
s t a t u s is t h e r e f o r e w a r r a n t e d .
c . S u c t i o n s o f t h e p h y s i c a l exam w h i c h a d d r e s s t h e h y p o t h e s i s
(refer

t o a t t a c h e d p h y s i c a l exam f o r m s )

4.
a.
Hypothesis
- The gener&lt;v, 1 p h y s i c a l h e a l t h of the
Vietnam
e x p e r i e n c e d p a r t i c i p a n t i s n o t d i f f e r e n t f r o m t h a t o f h i s twin.
b.
Rationale
- This
hypothesis w i l l
physical
c o n d i t i o n o f t h e twins t o d e t e c t
e f f e c t s of the Vietnam experience.
c. Sections of the p h y s i c a l

evaluate
the general
any unexpected
health

exam w h i c h a d d r e s s t h e h y p o t h e s i s

the
s e c t i o n s of the p h y s i c a l assessment not
enco HA p a s s e d
b y t h e h y p o t h e s e s 1 - 3 w i l l be u t i l i z e d t o e v a l u a t e t h i s
hypothesis.

THE PHYSICAL EXAM
CKaminution

to

assess

the

participant's

general

sir,, t t

of

�VETS - DRAFT 3 / 2 9 / 8 3 - FOR O F F I C I A L USE OMLY

health
blood
pressure,
weight,
height,
chest
c i r c urn f e r ea e e
(maximum
and rain imum &gt; , wa i s t c i i cumf e r eric e , skin
£ u id
thickness, pulse, t e m p e r a t u r e ,
Dermatologic examination
rushes,
hirsutism,
angiomata, etc

hyperpigmentixtion,

&amp; 1 o p e c; i &lt;-. , s p i d e r

document
lesions w i t h
photouraphs,
indicating
l o c a t i o n o f t h e p h o t o g r a p h b y r e f e r e n c e to t h e a
f i g u r e drawing

(refer

t o a t t a c h e d p h y s i c a l ex&lt;;m

the

forms)

HEALTH ASSESSMENT FOLLOW-UP

Emergent
I l l n e s s - If an i l l n e s s of &lt;in e m e r g e n t
n &lt;i t u i e
is
d i s c o v e r e d a t a n y t i m e d u r i n g a n y phase o f t h e h e a l t h a a e e s b i r i e n t .
Appropriate
h e a l t h c a r e s h a l l be p r o v i d e d &lt;i t g o v e r n m e n t estnen&amp;t.-.
The
project's
health
assessment
will
he
continued
only
if
medically justified.
N o n - e m e r g e n t I l l n e s s - At th« c o n c l u s i o n of, the VETS.' h e a l t h
assessment
p r o t o c o l , an " e x i t i n t e r v i e w " w i l l be p e r f o r m e d by a
b o a r d c e r t i f i e d i n t e r n i s t and p s y c h o l o g i s t w h o were n o t
involved
with
the
participant's evaluation.
The
participant's
entire
health
s t a t u s d u t a base w i l l b e r e v i e w e d a n d d i s c u s s e d w i t h h i m .
If i.\ n i l l n e s s of a non-emer gen t n a t u r e is s u s p e c t e d or d i s c o v e r e d
d u r i n g t h e h e a l t h assessment,
and i f f u r t h e r s t u d i e s m i g h t
help
define
that suspected or d i s c o v e r e d i l l n e s s within a maximum
of
three
d;-&gt;ys,
and i f t h e VETS s t a f f f e e l i t i s
appropriate.
the
participant
can
elect
to remain
for
further
e v a l u a t i o n . An
en a in p i e m i g h t
be
a
p a r t i c i p a n t who
has
epigastric
symptoms
consistant
with
a duodenal u l c e r . W h i l e an
assessment
for a
d u o d e n a ] u l c e r i s not p a r t o f t h e h e a l t h assessment p r o t o c o l ,
an
upper
g a s t r o - - i n t e s t i n a l r a d i o g r a p h i c series w i l l b e p e r f o r m e d if
recommended
b y t h e r e v i e w i n g VETS s t a f f a n d i f
the
participant
agrees.
Such
non-protocol
tests w i l l be performed at
the St.
L o u i s V e t e r a n s A d m i n i s t r a t i o n M e d i c &lt; v 1 C e n t e r at t h e V A ' s e a p e n s e .
D u r i n g t h e p e r i o d of non-- p r o t o c o l a s s e s s m &amp; n t , h o t e l a c c o m o d a t i o n s
and m e a l s
s h a l l c o n t i n u e to be p a i d *t3P* hy the p r o j e c t hut
the
p a r t i c i p a n t w i l l n o t r e c e i v e t h e d a i l y $100 compensation.
Follow-up care - If the p a r t i c i p a n t wishes,
a comprehensive
summary
o f h i s h e a l t h assessment w i l l b e p r e p a r e d a n d m a i l e d
to
his
private
physician
along w i t h a
record
of
any t r e a t m e n t

�VETS - DRAFT 3 / 2 9 / 8 3 - FOR O F F I C I A L USE ONLY

p r o v i d e d A n d f o l l o w - u p recommendAtions.

�</text>
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&lt;p&gt;For more about this collection, &lt;a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a"&gt;view the Agent Orange Exhibit.&lt;/a&gt;&lt;/p&gt;</text>
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&lt;p&gt;For more about this collection, &lt;a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a"&gt;view the Agent Orange Exhibit.&lt;/a&gt;&lt;/p&gt;</text>
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              <text>Series III Subseries III</text>
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                <text>Carroll, Ray</text>
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                <text>Letter: from Ray Carroll to Maurice [LeVois], August 26, 1982</text>
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                <text>Vietnam Experience Twin Study</text>
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                <text>study protocol</text>
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