1 15 86 https://www.nal.usda.gov/exhibits/speccoll/files/original/4c6719fed88cb5a01e25ead397124397.pdf de66c29f7a460f5a1c60136194467c0e PDF Text Text Item ID Number Author Anonymous Corporate Author Report/Article Title Health JOUmal/BOOk Title Chemical and Engineering News Year ws Month/Day A ril 16 Color rj Number of Images 1 DeSOrlpton Notes Alvin L Youn Hazard of Dioxins Still Uncertain P 9filed tnis item under the category "Human Exposure to Phenoxy Herbicides and TCDD" Tuesday, February 06, 2001 Page 390 of 526 �- 1- High-dosage Treatment with Cytostatics in Acute Myeloid Leukemia Source: Lakartidningen 1981; 79, pp. 2107-9 At the District Hospital in Umea. high-dosage treatment with cytostatics has been used since 1977 against myeloid leukemia. The results show that the frequency of remission is relatively high. The length of the remissions also appears to be extended as compared with the treatment with lower doses of cytostatics. The proponents are Brigitta Osterman, assistant chief physician with Dr, Lennart Hardell and Dr. Per Lenner and Dr, Christer Lindholm, section chief physician at the Incological Clinic. Jan Holm and Prof. Anders Wahlin are both chief physicians at the Medical Clinic, Prior to the 1960's the availabilities for treating acute myeloid leukemia were very limited. Remissions occurred in less than 15 percent of the patients and as a rule were of short duration. Since anthracycline preparations and cytosin-arabinoside were introduced in the treatment of acute myeloid leukemia at the end of the 1960's the frequency of remissions has increased to more than 50%. The patients who go into remission have an average survival period of ca. 1 1/2 years (1, 2). Since the middle of the 1970's the results of treatment have been noticeably improved after the introduction of intensified induction treatment with combinations of cytostatics in massive doses of myelosurppressives. Complete remissions in 60 - 85 percent of previously untreated patients has been reported by inter al. Glucksberg and collaborators, Gale, Gale and Cline and Vaughan and collaborators ( - ) 38. Intensified induction treatment therefore provides remission in the majority of patients, but to date a prolongation of the duration if the remission could not be evidenced. Recently it was reported that patients can remain in remission for five or more years ( ) 9 . After several years in remission the risk for relapse is regarded as being small. Since January 1977 at the District Hospital in Umea an intensive treatment program has been used in acite myeloid leukemia. We will show here our experiences in this treatment, which is a modification of a treatment progran published by Glucksberg and collaborators in 1975 (3) PATIENTS AND METHODS The high-dosage treatment in accordance with Fig. 1 was given in the period January 1977 ti September 1981 to 28 patients. Two patients were not observed inone month, but 26 patients who could be evaluated are shown. A total of 56 patients with acute myeloid leukemia were evaluated during the actual period. The 28 patients (ages 5o to 93 years, average age 79 years) who did not receive high-dosage treatment received individualized cytostatic therapy. The high-dosage treatment with cytostatics was afministered to patients unser 65 without previously known complicating sickness such as serious heart disease. One patient was in such good condition that he was regarded as being capable of tolerating the treatment despite his advanced age. The youngest patient who received high-dosage treatment was 18 years old, and the average age was 45 years. All patients had not been treated previously. Patuents who developed acute leukemia from a previoys condition, for example, pre-leukemia or another myeloid proliferative disease, were not included in the program. �- 2- The morphological system classification according to the FAB-system (10) was used for diagnosis. Nine patients had acute leukemia of the MI type (myeloblastic leukemia without development), fourteen of the M^ type, (myeloblastic leukemia with coincidental development) two cases diagnosed as M^ (myelo—monocyte leukemia) and one which was diagnosed as M5 (monocyte leukemia). Complete remission means normalizatoon of the bone marrow picture and blood status and absence of any signs of remaining leukenia cells, for example leukemic organ infiltration for at least one month. The calculation of the survival time and remission duration was performed according to Kapkan and Meier (11). RESULTS In 16 (65 percent) of the 26 patients complete remission was obtained (Fig. 2), The average period for the length of the remission was 32 months. The average survival time for the 17 patients who went into remission was 35 1/2 months (Fig. 3) and for all patients 32 months. The nine patients who did not go into remission survived for a maximum of six months (The average was 1 1/2 months). The causes of death were intracranial bleeding, sepsis and pulmonary embolism in one case. No patients died during the course of remission. INDUCTION TREATMENT After a 10-day interruption in treatment an evaluation of the bone marrow was performed. If there was no remission induction treatment was resumed. In the case of hypoplasia the interruption was prolonged. Further treatment was rendered in the case of continued absence of remission. Daunorubicin 50 mg/m2 body volume (max. 100 mg) intravenous: day 1,2,3 Cytosinarabinosid 80 mg/m2 body volume x 2 intravenous day 1-6 6-tioguanin 140 mg/m2 body volume orally day 1-6 Vincristine 2 mg intravenously day 1 CONSOLIDATION TREATMENT Consolidation treatment was given when remission occurred. after a 3-week interruption Daunorubicin 50 mg/m2 body volume intravenous Cytosinarabinosid 80 mg/m body volume x 2 intravenous 6-tioguanin 140 mg/m2 body volume orally day 1 & 2 day 1-5 day 1-5 MAINTENANCE TREATMENT One treatment series each month. Treartment A: 1, 2, 3, 5 .. months after the consolidation treatment. Treatment B: 4, 8 and 12 months after the consolidation treatment. After a year's treatment only treatment according to A every other month. Usually the treatment was terminated after two years in remission. Treatment A: Cytosinarabinosid 80 mg/m body volume intravenous 6-tioguanin 140 mg/m2 body volume orally Treatment B: Daunorubicin 50 mg/m2body volume intravenously Cytosonarabinosid 80 mg/m2body volume intravenous 6-tioguanin 140 mg/m2 body volume ofally Fig. 1: High-dosage treatment. day 1-5 day 1-5 day 1 day 1-3 dat 1-3 �- 3TOXICITY In conjunction with the induction therapy all patients developed serious bone marrow depression. Less tan 0.2 x 10 /granulocytes in the peripheral, blood was noted on a average of 24 days in the patients who went into remission. Many patients lost all the granulocytes in the peripheral blood during some period. There were no granulocyte transfusions. The patients were treated in the normal wards without possibility for isolation in a sterile environment. Twenty-four of the 26 patients became ill during the granuloctopenia period with seotic high fever which persisted for approximately one week. Cultures prepared from blood, throat and urine before antibiotics therapy were usually negative, as were x-rays of the lungs. Antibiotic treatment was usually given with carbenicillin and aminoglycosides if there was not positive culture result. Since the the number of granulocytes in the peripheral blood was normalized, all patients became afebrile with rapid improvement of the general condition. Thrombocytepenia with values below 20 x 109/1 was noted in 25<of 26 patients after induction treatment. Thrombocyte transfusions were administered with a value below 10 x 109/1 or at the indication of haemhorrage. On the average approximately 10 thromboconcentrates were administered per patient. Since 1979 the thrombocyte concentrate has been prepared from the so called buffy coat from the blood donors. As a rule eight blood donors are required to produce one thrombocyte concentrate. When the remission began the thrombocyte value was normalized in all cases within a few days. Erythrocyte transfusions were administered at Hb-values below 8 g/1, and each patitent on the average received 24 erythroconcentrates during the induction phase. Most of the patients felt ill and were nauseous during the induction treatment. Some felt ill also in conjunction with the maintenance treatment (chemotherapy), In all cases Iqss of hair occurred during the induction phase, but the hair growth was normalized later in all patients. Mucuous membrane reactions in the oral cavity and throat with the epithelium and often with involvement of the esophagus were complicating side effects with the majority of patients. This was often further complicated by fungal and viral infections. The problem however receded rapidly when the blood picture, was normalized. Four patients developed severe wide-spread musvular pains on the first daysafter the induction treatment. Two patients developed polyneuropathy, which was regarded as being caused by the vineristine treatment. Heart involvement is a well known side effect of the anthracycline preparation with high total doses. Such an effect was not noted in some patients during induction treatment. The heart volume and the physical capscity for work were normal in the patients who were examined with continued complete remission and after treatment, had begun. However, four patients became ill with acute cardiac symptoms 5 to 32 months after treatment had begun. None of them had signs of infection or fever when the complaint began. In all cases a new development of cardiac problems was noted because-of exudative pericarditis. After treatment was begun with digitalis, diuretics and steroids the heart volume was normalized within 10 days, and the patients did not manifest any signs of cardiac involvememt during continued treatment. �- 4- DISCUSSION •'•-.";••;• Seventeen (65 percent) of 26 patients with acyte myeloid leukemia experienced complete remission in high-dosage treatment with cytostatics. Thos frequency is comparable to that which has been most recently reported with similar therapy programs ( - ) It is apparent that this type of 38. high-dosage treatment provides a higher degree of remission frequency than treatment with lower doses of cytostatics. The average survival period for all 26 patients was calculated as being 32 months. The material on the patients is relatively low, but we regard this figure as being encouragingly high. (. 1 i 100 100 yj 3fjfl f I 4 A < BO "I & Id UJ K geo ll I i \ 40 ig I B i *O w t 1 L.., h_ 40 i20 . L_JL n .1 20 r i 10 20 30 40 MONTHS SO GO MANAOER Fig. 2: Survival without relapse for the entire program (26 patients). "1" shows the length of the observation period for living patients. ' \^\ in t it » ^j ^ 0 "~1 In 0 i si_ _l 1O 20 "" 30 4() Months * 50 ^ 60 MANAOER Fig. 3: Survival. A » patients which went into remission (17). B - the entire program (26), C = patients who did not go into remission. In the high-dosage treatment of acute myeloid leukemia the side effects are usually in the form of sepsis, haemorrhage,' mucous membrane reactions, etc. There is a critical requirement for monitoring,prophylaxis and treatment of complications. Despute this we'note that this type of treatment is indicated and can be performed at hospitals which have experience with such treatment and which have sufficient resources, particularly for the preparation of thrombocyte concentrate. This recommendation is based upon the high remission frequency and the relatively long survival time. Our program illustrates a number of well known facts, specifically that^complete remission is a requirement for the patient to be able to survive. The average survival time for patients who did not go into remission was only 1 1/2 months, while the survival time for those who did go into remission was 35 1/2 months. Unfortunately, most of the patients suffered relapse of the disease. �5 - | The possibilities for realizing a second remission ate considerably l^fss than with the first fillness. \ Even if there should be reports of improved possibilities for inducing afsecond remission, currently the major problem today is to prevent relapse after remission is realized. Bone marrow transplants currently give the best possibility for preventing relapse after remission has been realized (12). Encouraging results have been obtained at the Huddinge Hospital. Brigitta Osterman Jan Holm Christer Lindhoolm Lennavt Eavdell Per Lennev Anders Wahl-in BIBLIOGRAPHY 1. Gunz FW, Vincent PC. Towards a cure of acute granulocytic leukemia? Leuk Res 1977;l:51-66. 2. Freirekh EJ, Keating Ml, Gehan EA et al. Therapy of acute myelogenous leukemia. Cancer 1978;42:874-82. 3. Glucksberg H, Buckner CD, Fefer A et al. Combination chemotherapy for acute nonlymphoblastic leukemia in adults. Cancer Chemother Rep 1975:59:1131-7. 4. Glucksberg H, Cheever MA, Farewell VT et al. High-dose combination chemotherapy for acute nonlymphoblastic leukemia in adults. Cancer 1981:48:1073-81. 5. Gale RP. Advances in the treatment of acute myeiogenous leukemia. N Engl J Med 1979:300:1189-99. 6. Gale RP, Cline MJ. High remission-induction rate in acute myeloid leukaemia. Lancet l977;i:497-9. T."Vaijjghaif VP, "KaTp IE; Burke PJ.-Long chemotherapy-free remissions after singlecycle timed-sequential chemotherapy for acute myelocytic leukemia. Cancer 1980:45:859-65. K Paul C, Bjorkholm M, Christcnson J et al. Comparison of daunorubicin and daunonibicin-DNA complex in the treatment of acute nonlymphoblastic leukemia. Cancer Chemother Pharmacol 1981;6:65-73. 9. Peterson B, Bloomfield CD. Long-term disease-free survival in acute nonlymphocviic leukemia. Blood 1981:57:1144-7. 10. Bennett JM, Catovsky D, Daniel MT et al. Proposals for the classification of the acute leukaemias. BrJ Hacmato! 1976:33:451-8. 11. Kaplan EL, Meier P. Nonparametric estimations from incomplete observations. J AmStatAssoc 1958:53:457-81. 12. Powles RL, Clink HM, Bandini G et al. The place of bonemarrow transplantation in acute myelogenous leukaemia. Lancet — 1980;i:l04750. 13. Ringdln O. B&ryd I, Gahrton G et al. Benmargstransplantatiort vid akut Icukemi, indikationer, prognos och erfarenhcter vid Huddinge sjukhus. Sv Liikaresallskapcls handlingar 1980:89:128. �viindande av plant.eringskapp respektive svampklamma visar pa en betydligt mindre besvarsfrekvcns an i tidigare rapporterade undersokningar i samband med bantering av doppade barrtrfidsplantor. Liksom i tidigare studier noterades ingen ma'tbar utsondring i urinen av permetrinmetaboliter och endast nagot enstaka prov bar visat matbara halter i luften under arbete. Angtrycket fdr permetrin ar lagt [4] varfdr nagon risk for inandning av preparatet inte torde fOreligga. Mycket iaga halter i inandningsluften ffireliggcr dock ibland vid uppmatta lufthaltsbestamningar. Hur nysningsbesvar skall tolkas, korn av a'mne eller angpartiklar, kan inte avgoras, Dar subjektiva besydr nu rapporterats tycks framfOr allt Ipitox ha anvants till anvandning. Detta kan tolkas som att Ipitox i sin nuvarandc beredningsform (slampulvcr = wettable powder) ger en storre besvarsfrekvens an Ambush som ar en emulsion. Bctraffande de tidigare rapporterade hudbesvaren har den nu aktuella hudtestningen inte givit bclagg for att besvaren ar att betrakta som allergiska, utan sannolikt ar de att betrakta som uttryck fOr en direkt irritativ hudeffekt. Det b6r ocksa noteras att senare undersokningar [5] pa mus visat att permetrin kan vara hudpcnetrerande och detta skulle kunna forklara besvar av typ-stickningar och domningar som uttryck fdr en lokalt snabbt overgaende ncrvretning till foljd av hudupptag hos personerna i var undersOkning. Toxikologiska data anger LD/50-vardet fdr den aktiva substansen (hanratta peroralt) till I 480 mg/kg kroppsvikt. Betraffande formuleringen har pa rattor av bada kflnen minsta tbxiska dos oralt beriiknats i ill mer an 2 000,mg/kg. Den akuta toxiciteten ar alltsa lag. Permetrin har inte givit ogonirritation i kaninOga, och inte heller visat sig vara allergiframkallande. Betraffande kronisk toxicitet har man vid djurfOrsok pa saval ratta som hund iakttagit leverpaverkan, samt pa ratta viss pdverkan pa perifer ncrv med hOga doser. Nagon okad risk for tumOrer eller fosterpayerkan anses inte foreligga [4]. Aven om de nu prflvade metoderna innebar en klar forba'ttring av subjektiva besvar fran hud och luftva'gar kan det dock medfOra andra arbetsmiljoproblem, namligen av ergonomisk art. Sa t ex upplevs planteringsrOret av vissa som tungt och det fOreligger en risk for uppkomst av tendinitbesvar.i armbage och handled pa grund av ensidiga rOrelser av armen i samband med tryck runt varje planta vid anvandande av svampklamma under langre tid. ViktiMssigt ar dock svampklamman att foredra framfOr planteringskappen. Sammanfattning Detta pilotfOrsOk har visat att arbete med. planteringskiipp eller svampklamma medfOr en klar minskning av frekvensen subjektiva besvar. Vidare tycks Ambushi!e mindre besvarsfrekvens iin Ipitox i sin inivarande beredningsform. Avcn om de nya bchandlingsmetoderna an sa la'ngc har ^flogdosbehandling med cytostatika vid akut myeloisk leukemi Vid regionsjukhuset i Urne! har sedan 1977 hogdosbehandling med cytostatika anva°nts vid akut myeloisk leukemi. Resultaten visar att remlsslonsfrekvensen ar forhallandevis hog. Remisslonernas ISngd fdrefaller ocksa att f6rISngas ja'mfdrt med vid behandling med la'gre cytostatikadoser. Av forfattarna 8r Birgltta Osterman bltradande overlSkare, med dr Lennart Hardell och med dr Per Lenner samt Christer Lindholm avdelningsiakare vid onkologiska kliniken. Jan Holm och decent Anders Wahlin a> bada avdelningslSkare vid medicinska kliniken. Fore 1960-taIet var bchandlingsmdjlighctcrna vid akut myeloisk leukemi mycket begransade. Remissioner fOrckom hos mindre an 15 proc av patientcrna och var i regel kortvariga. Sedan antracyklinpreparaten och cytosin-arabinosid introducerats i behandlingen av akut myeloisk leukemi i slutet av 1960-talct har remissionsfrekvensen stigit till mer a'n 50 proc. De patienter som gar i remission uppvisar en medianoverlevnadstidpacal V 2 ar[l,2]. Sedan mitten av 1970-taIet har behandlingsresultaten ytterligare fOrbattrats efter inforandet av intensificrad induktionsbehandling med kombinationer av cytostatika i kraftigt myelosuppressiva doser. Kompletta remissioner hos 60-85 proc av tidigare obehandlade patienter har rapporterats av bl a Glucksbcrg och medarbetare. Gale, Gale och Cline samt Vaughan och medarbetare (3-8). Intensifierad induktionsbehandling gcr alltsa remission hos flertalet patienter, men man har a'nnu ej sSkert kunnat pavisa nagon forlangning av femissionens varaktighet. Nyligen har dock rapportcrats att upp till 27 proc av patienterna kan forbli i remission i fern ar eller iner [9]. E.fter flera ar i remission anses risken for aterihsjttk-' nande vara liten. Sedanjanuari 1977 anvands vid regionsjukhuset i Umea ett intensivt behandlingsschema vid akut myeloisk leukemi. Vi redovisar har vara erfarenheter av denna behandling, som utgOr en modifiering av ett behandlingsprogram publicerat av Glucksberg och medarbetare 1975 [3]. Patienter och metoder Hogdosbehandling enligt Figur 1 gavs under perioden januari 1977-September 1981 till 28 patienter. Tvi patienter har a'nnu ej observcrats i en manad, varfor 26 evaluerbara patienter redovisas. Totalt vardades under den aktuella perioden 56 patienter med akut myeloisk leukemi. De 28 patienter (alder 50-93 ar, median 79 &i) som ej tick hogdosbehandling erhdll individualiserad cytostatikaterapi. HOgdosbehandling med cytostatika gavs till patienter under 65 ar utan tidigare kand komplicerandc sjukdom sasom allvarlig hjartsjukdom. En patient var i sa gott tillstand att hon ansags ha mdjlighet att tala behandlingen trots hogre alder. Den yngste patientcn som erholl hogdosbehandling var 18 ar, och medianaldern var 45 ar. Samtliga patienter var tidigare obehandlade. Patienter som utvecklat akut leukemi ur predisponerande tillstand, t ex prelcukemi eller annan myeloproliferativ sjukdom, ingar ej i materialet. For diagnos anvSndes moirfologisk klassifikation enligt FAB-systemct [10]. Nio patienter hade akut leukemi av typ M, (myeloblastleukemi utan utmognad), Ijorton av typ M2, (myeloblastleukemi med samtidig utmognad), tya fall diagnostiserades som M4 (myelo-rhonocytleukemi) och en som M5 (monocytleukemi). Med komplett remission avscs normalisering av bcnmargsbild och blodstatus samt avsaknad av andra tecken pa kvarvarandc leukemiceller, t ex Icukemiska organinllltrat, under minst en manad. Berakning av overlevnadstid och remissionsduration har utforts enligt Kaplan och Meier [11]. Resultat Hos 17 (65 proc) av dc 26 patienterna ernolls komplett remission (Figur 2). Mediantiden for remissionens langd var 32 - manader. Median Overlevnadstid for de 17 patienter som gick i remission var 35 '/2 manader (Figur 3) och for samtliga 26 patienter 32 manader. De nio patienter som ej gick i remission dverlcvde som anvants under alltfor kort tid fOr att man skall kunna vardera evcntuella ergonomiska problem tycks det dock fran yrkesmedicinsk synpunkt vara efterstravansvart att sa langt som mojligt minimera doppningcn. Birgilta Kolmodin-Hedman Christer Edling Torkel Fischer Gertie Rand Malin Akerblom Yrkcshygienisk Institutt, 1980. (Rapport s 21). 2. Kolmodin-Hedman B, Lundbcrg I, Sjogren B, Swensson A. Intervjuuncersftkning rOrande bcsvSr i samband med anvandning av syntetiska pyretroidcr for snylbaggebekampning. Solna: Arbeiarskyddsstyrelsen, 1980. (Undersokningsrapport 1980:2). 3. Kolmodin-Hedman I), Swensson A, Akerblom M. Occupational exposure to some synthetic pyrethroids, permcthrin and fenvalerate. Arch Toxicol (in press 1982). 4. Bystedt M, Kolmodia-Hedman B. Nordiska clokumcntaliansgcuppen: pej-melrin. Arbete_ Lttteratur 1. Edling C, Johansson S, Larsson L, Olsberg M. Fiiltstudicr av yrkesmassig exponcring for permetrin (Ipitox 25 WP). Oslo: Norsk 5. Shah.PVv Monroe RJ, Guthric FE. Comparative rates of dermal penetration of insecti' cides in mice. Toxicol Appl Pharmacol 1981:59:414-23. och Halsa (under publ 1982). 2107 �^mission vid hdgdosbchandling med cytostatika. Denna frekvens ar jamforbar med den som under senaste ar bar rapporlerats vid anviindning av liknande behandlingsprogram [3-8]. Det ar uppenbart att denna typ av h&gdosbehandling ger hogre remissionsfrekyens an behandling med lagre cytostatikadoser. Mediandverlevnadstiden for samtliga 26 patienter berftknades till 32 manader. Patientmaterialet iir relativt litet, men vi finner denna siffra uppmuntrande hOg. . Vid hogdosbehandling av akut myeloisk leukemi ar biverkningar vanliga i form av sepsis, blodningar, slemhinnereaktioner etc. Stora krav stalls pa dvervakning, profylax och behandling av komplikationer. Trots det anser vl att denna typ av behandling ar indiccrad och genomfOrbar vid sjukhus som bar erfarenhet av sadan behandling och som .bar tillrackliga rcsurser, framfdr allt for framstallning av trombocytkoncentrat. Delta stallningstagande motivcras av den hoga remissionsfrekvensen och den jamffirclsevis langa overlevnadstiden. Van material illustrerar ett numera valkant faktum, namligen att komplett remission ar en Krutsattning for att patienten skall kunna Sverleva. Medianpverlevnadstiden Ktr patienter som ej gick i remission var endast 1 V2 manad, medan den for dem som gick i remission var 35 Vj manader. Tyvarr recidiverar sjukdomen hos de allra fiesta patienterna. Mojlighcterna att astadkomma en andra remission ar betydligt mindre an vid forsta insjuknandet. . Aven om det borjar komma rapporter om fdrbattrade mojligheter att inducera en andra remission, ar det i dag mest angeISgna problemet att forhindra recidiv cftcr uppn&dd remission. Behmargstransplantation forefaller f n erbjuda den basta mojligheten att forhindra recidiv efter uppnadd remission [12]. Uppmuntrande resultat bar ocksa redovisats pa Huddinge sjukhus [13]. Birgitta Osterman Lennart Harriett Jan Holm Per Lenner Christer Lindholm Anders Wahlin I Litteratur !. Gunz FW, Vincent PC. Towards a cure of acute granulocytic leukemia? Leuk Res 1977:1:51-66. 2. Freireich El, Keating MJ, Gehan EA et al. Therapy of acute myelogenous leukemia. Cancer 1978:42:874-82. 3. Glucksberg H, Buckner CD, Fefer A et al. Combination chemotherapy for acute nonlymphoblastic leukemia in adults. Cancer Chemother Rep 1975:59:1131-7. 4. Glucksberg H, Cheever MA, Farewell VT et al. High-dose combination chemotherapy for acute nonlymphoblastic leukemia in adults. Cancer 1981;48:1073-81. 5. Gale KP. Advances in the treatment of acute myelogenous leukemia. N Engl J Med 1979:300:1189-99. f,. Gale RP, Cline MJ. High remission-induction rate in acute myeloid leukaemia. Lancet l977;i:497-9.""TrVaupaii'VF.'Karp'lErBarlre-PJr-Long chemotherapy-free remissions after singlecycle timed-sequential chemotherapy for acute myelocytic leukemia. Cancer 1980:45:859-65. li. Paul C, Bjflrkholm M, Christenson J et al. Moped- och motorcykelakning - en vardkravandefritidssysselsattning Antalet olyckor med tvahjuliga motorfordon har 6kat under senare ar. Det ar huvudsakligen unga individer som skadas, och tre fjardedelar av skadorna ar av ortopedkirurgisk karaktar. Omkring en fja1 rdedel av alia skadade fidrar sig sa allvarliga skador att de behdver tas in i sluten vard. Vardtiden i sluten vard a> lang - for samtliga skadetyper ar genomsnittet drygt 30 dagar och for skador av ortopedkirurgisk karaktar hela 43 dagar. Problemet penetreras ha'r av med dr Axel Engstr&m, avdelningsiakare vid prtopedkirurglska kliniken, Akademiska sjukhuset, Uppsala. Pa senare ar har man 6vcr hela varlden registrerat ett stigande antal motorcykelolyckor. I manga fall har Okningen av antalet olyckor varit storre an okningen av antalet inrcgistrerade motorcyklar. Vid stdrre trafikmedicinska undersokningar kommer ofta motorcykelolyckorna i skymundan p§ grund av att de totalt sett oftast ar farre an antalet bilolyckor. Det olycksfdrcbyggande trafiksakerhctsarbetet fokuseras darfor som regel pa bilolyckorna. I manga avseenden avviker motorcykelolyckorna fran flvriga trafikolyckor, Motorcykeltrafikanterna ar dels sa gott som belt oskyddade, dels tillhor de huvudsakligen de yngsta aldersgrupperna bland vara trafikanter. Genom tcknikens framsteg har prestanda hos de tvahjuliga motorfordonen — delta gailer savil mopeder som motorcyklar - vascntligen C6randrats. Dagcns moped har mycket litet gemcnsamt med den moped av typ hjalpmotorforsedd cykel som vara lagstiftare en gang i tiden bedomde lamplig att framforas av fcmtonaringar utan foregaende kunskapsprov. For dc st6rre motorcyklarna har savai cylindervolymerna som den ur cylindervolymen uttagna effckton successivt okats, och man har i manga fall natt extrema forhallanden mellan motoreffckt och fordonsvikt. Man kan utan overdraft saga att vissa Comparison of daunorubicin and daunorubicin-DNA complex in the treatment of acute nonlymphoblastic leukemia. Cancer Chemother Pharmacol 1981:6:65-73. 9. Peterson B, Bloomfleld CD. Long-term disease-free survival in acute nonlymphocytic leukemia. Blood 1981:57:1144-7. 10. Bennett JM, Catovsky D, Daniel MT et al. Proposals for the classification of the acute leukaemias. Br J Haematol 1976;33:45l-8. 11. Kaplan EL, Meier P. Nonparametric estimations from incomplete observations. J Am Slat Assoc 1958:53:457-81. 12. Powlcs RL, Clink HM, Bandini G et al. The place of bonemarrow transplantation in acute myelogenous leukaemia. Lancet • —1980;i:1047-50. 13. Ringd6n O, BSryd I, Gahrton G ct al. Benmitrgstransplantaiion vid akut leukemi, indikationer, prognos och crfarenhcter vid Huddinge sjukhus. Sv Lakaresallskapets handlingar 1980:89:128. UJ motorcyklar har vuxit fran manniskan, och vara motorcykclimportftrer har ocksa for ett par ar sedan spontant sanerat bort de motorstarkaste maskinerna genom att inte langre importera motorcyklar med motorstyrkor fiver 100 hastkraftcr. N&gon pataglig effekt pa olycksstatistiken kan dock inte en sadan marginell atgiird ha. Mer an halften av alia ungdomar som avlider i Sverige dor pa grund av trafikolyckor. En stor del av de trafikskador som drabbar tonaringar och unga manniskor upp till 25 ars alder har Mragits i samband med fard pa moped eller motorcykel. FOr aldersgruppen 15-17 ar svarar moped- och motorcykelolyckorna for drygt hMften av alia olycksfall som registreras i den offentliga statistiken. For att ge en bild av det sjukvardsbehov som uppstar pa grund av moped- och motorcykclolyckor gjordes 1979 en redovisning av skador och skadepafoh'der for tva patientmaterial fran Uppsala Ian [1]. Det ena patientmaterialet bestod av 213 personer som vardats i sluten vard vid Akademiska sjukhuset, Uppsala, under aren 1971-1974 pa grund av skador adragna vid fard pa moped eller motorcykel. Uppl'dljningstiden for detta patientmaterial varierade mellan tre och sex ar. Det andra patientmaterialet utgjordes av samtliga de personer, totalt 193, som under ettarsperioden 1 april 1976-31 mars 1977 sokte lakarvard i Uppsala Ian pa grund av skador adragna vid fard pa moped eller motorcykel. Omstiindighcter krlng olyckorna Av undersokningarna framgar att moped- och motorcykelakning alltmcr har blivit en fritidssysselsattning; endast 16,1 procent av de skadade hade skadats vid nagon form av nyttotrafik. Drygt halften av samtliga patienter hade skadats vid singelolyckor, och endast 34 procent hade skadats vid kollisioner med andra fordon, vilket avviker fran den gangse uppfattningen [2] att kollisioner med andra fordon ar den for tvahjuliga motorfordon vanligaste olyckstypen. De fiesta mopedister och motorcyklister skadas i nara anslutning till den for det aktuella olycksfordonet legala debutaldern. Drygt 46 procent av mopedforarna hade annu inte fyllt 16 ar vid skadetillfallet, och drygt 40 procent av forarna pa latt motorcykel hade inte uppnatt 17 ars alder. Drygt 80 procent av dem som skadats vid fard pa tung motorcykel var hflgst 26 ar gamla. Forarna ar pafallande ofta ovana vid det aktuella olycksfordonet. Omkring 17 procent av olycksforarna kan bodomas ha varit helt ovana vid fordonet (mindre an tvfi dagars fordonsvana), och drygt 50 procent av fordonsfdrarna hade mindre an sex manadcrs erfarenhet av det aktuella -olyeksfordonet. 19 procent av-de motor-. _ cykclforare som skadades vid fard pa allmUn vag, saledcs nastan varfemte maloccykelforare, saknade korkort vid olyckstillfallet. 2109 o -CO* N. UJ r. o E a. O CO ii Q UJ o UJ i o i DC a. UJ CO UJ UJ O a �INDUKTIONSBEHANDLING Eftet ID dagars behandlingsuppehall gjordes beddmning av benmBrgen. Vid hypoplasi .fdrlangdes uppehailet. Om ej i remission gavs ny Induktionsbehandling. Vid fortsatt utebliven remission gavs ytterligare behandlingar. / Daunorubicin 50 mg/m2 kroppsyta (max 100 mg) intravendst Dag1,2och3 Cytosinarabinosid 80 mg/m5 kroppsyta x 2 intravendst Dag 1-6 6-tioguanin 140 mg/m2 kroppsyta peroralt Dag 1-6 Vinkrlstin 2 mg intravendst Dag 1 KONSOLIDERINGSBEHANDUNG Konsolideringsbehandling gavs efter 3 veckors behandlingsuppehall vid intraffad remission. Daunorubicin 50 mg/m2 kroppsyta intravendst Dag 1 och 2 Cytosinarabinosid 80 mg/m' kroppsyta x 2 intravenflst Dag 1-5 6-tioguanin 140 mg/m2 kroppsyta peroralt Dag 1-5 UNDERHAlLSBEHANDLING En behandlingsserie varje manad. Behandling A: 1, 2, 3, 5... manader efter konsolideringsbehandlingen. Behandling B: 4, 8 och 12 manader efter konsolideringsbehandlingen. Efter ett ars behandling endast behandling enligt A varannan manad, I regel avslutades behandlingen efter tva ar i remission. Behandling A: Cytosinarabinosid 80 mg/m2 kroppsyta intravenost Dag 1-5 6-tioguanin 140 mg/m2 kroppsyta peroralt Dag 1-5 Behandling 8: Daunorubicin 50 mg/m2 kroppsyta intravendst Dag 1 Cytosinarabinosid 80 mg/m2 kroppsyta intravendst Dag 1-3 2 6-tioguanin 140 mg/m kroppsyta peroralt Dag 1-3 Figur 1. Hogdosbehandling. langst i sex manader (median I V2 manad). Dodsorsakerna var intrakranicll blodning, sepsis och i ett fall lungemboli. Ingen patient avled under pagacnde remission. periodcn i septisk hog feber som varade i omkring en vecka. Upprepade odlingar fran blod, svalg och urin fore insatt antibiotikaterapi var oftast negativa, sa aven lungrontgenundcrsokningar. Antibiptikabchandling gavs i regel med Toxicitet karbenicillin och aminoglykosider om poI samband med induktionsbehandlingen sitiva odlingssvar saknades. Da antalet Tick samtliga paticnlcr grav bunmargs- granulocyter i perifert blod normaliseradeprcssion. Mindre iin 0,2 x 10*/1 granu- des blev samtliga patienter inom nagra locyter i perifert blod noteradcs under i dagar afebrila med snabbt forbSttrat allmedcltal 24 dagar hos de patienter som mantillstand. gick i remission. Manga patienter saknade Trombocytopeni med varden under 20 belt granulocyter i pcrifera blodet under x I09/l noterades hos 25 av 26 patienter nagon period. Granulocyttransfusioner efter induktionsbehandling. Trombocytgavs dock ej. transfusioncr gavs vid varden under 10 x Paticnterna behandladcs pa vanlig vard- I09/l eller vid tecken pS blodning. I geavdelning utan mojlighet till isolering i nomsnitt gavs prnkring 10 trorhbocytkonr steril miljo. Tjugofyra av de 26 patienter- central per patient. Sedan 19.79 framstalls na insjuknade under den granulocytopena trombocytkoncehtrat fran's k buffy coaf Figur 2. Recidivfrl overlevnad for hela materialet (26 patienter). »1» illustrerar observationstidens ISngd fbr levande patianter. fran blodgivare. I regel erfordras aita blodgivare fur framstallning av ett trombocytkoncentrat. Vid begynnande remission normaliscrades trombocytvardet j samtliga fall inom n&gra dagar. Erytrocyttransfusioner gavs vid Hb. varden under 80 g/1, och varje patient erholl i medeltiil 24 erytrocytkoncentrat under induktionsfasen. De fiesta patienterna blev illamaende och kraktes under induktionsbehandling. en. Somliga m&dde ilia fiven i samband med underhallsbehandling. I samtliga fall forekom haravfall under induktionsfasen, men haryaxtcn tiormaliserades senare hos alia patienterna. Slcmhinncrcaktioner i munhala och svalg med cpitelit och of I a avcn tecken pa esofagit var besvarandc biverkningar hos majoriteten av patienterna. Detta komplicerades ofta ytterligare av svamp- och virusinfektioncr. Besvaren gick dock snabbt tillbaka da blodbilden normaliserades. Fyra patienter lick svSr diffus muskelviirk de forsta dagarna efter induktionsbehandlingen. Tva patienter utvecklade polyneuropati, som bedomdes vara fororsakad av vinkristinbehandling. Hjartpaverkan ar en valkand biverknini' av antracyklinpreparat vid hdga total doser. Sadan plverkan sags ej hos nagon patient under induktionsbehandlingen. HjSrtvolym och fysisk arbetsfdrmaga var ordinara hos de patienter som undersoktes vid fortsatt komplett remission ett ar efter paborjad behandling. Dock bar fyra patienter insjuknat med akuta hjartsymtom 5-32 manader efter pabdrjad behandling. Ingen av dem hade tecken pa infektion eller feber nar besvaren debuterade. I samtliga fall konstaterades nytillkommen hjartforstoring beroende pa exsudativ perikardit. Efter insatt behandling med digitalis, diuretika och steroider normaliserades hjartvolymen inom 10 dagar, och patienterna uppvisade i det fortsatta forloppet inga tecken till hjartpaverkan. Dtskusslon Sjutjon (65 proc) av 26 patienter med akut .myeloisk leukcmi erholl komplett Figur 3. dverlevnad. A » patienter som gatt I remission (17). B = hela materialet (26), C = patienter som ej gatt I remission (9). �lades 500-1 000 planter per dag. Denna i nagon form, dock utan aktuella utslag. variation berodde pi terra'ngfo'rhallandena En hade tidigare ka'nd Iuftr6rskatarr/brondar ej markberedda hyggen medforde en kit. Elva pcrsoner uppgav att de var rdkaminskning av arbetstakten. 24 pcrsoner re och 26 att de var icke-rtykare (Tabell 7 hade arbetat med Ambush och fern med II). Ipitox medan atta inte angav vilken preDe 37 mannen hade arbetat i 1-5 dagar parattyp som nyttjades. och mangden plantor som behandlades med svampklamma varierade mellan 500 Exponerlngsstudic och 1 000 per dag. Av de 37 hade 34 (92 Under arbete med svampklSmma fdlj- procent) inte upplevt nagra subjektiva bedes fyra man med individburen provtag- sva'r under arbetet. En person hade anginingsutrustning. Samtliga arbetade med vit nysning vid behandling med Ipitox och prcparatet Ambush, och en arbctsdag per en hade angivit 6gonbesva'r vid anva'ndperson studerades. I tva fall skedde in- ning av Ambush, men endast under en av samling av permetrin pa milliporfllter och de fern dagar han arbetade. En person i tva fall pi impingerflaskor dar etanol var som angivit domning i lapparna hade inte uppsamlingsvatskan. Luftflo'det var 1 li- noterat vilken preparattyp som fdrekom. ter/minut och provsamlingslid ca 60 minuVad ga'ller det rent praktiska handhater. Urinprov skulle lamnas i omcdelbar vandet av de nu aktuella hjalpmedlen noanslutning till avslutat arbcte och morgo- teras att pafyllning av svampklamman nen efter. skall ske genom iskruvande av fardiggangVidare foljdes tre personer (2 kvinnor, 1 ad preparatflaska med instruktion om att man) under arbete med planteringskapp. handskar skall anvandas. Nagon enstaka person anvande langSamfliga anva'ndc preparatet Ipitox. Uppsamling av permetrin skedde med etanol i skaftad handske och dvriga kort vinylimpingerflaskor. Flodet var 1 liter luft- hand ske och/eller plastad tyghandskc. /minut och fyra arbetstimmar studerades. Pafyllningsmoment skedde utan' missUrinprov uppsamlades efter arbetsdagens o'den, men under de forsta dagarna rann slut sarm pafoljande morgon. det fran a'nden pa svampklamman for tv& personer, varfo'r man inffirde motorsagsHudlest dunkslock (Husqvarna motorsag), vilket Under varcn 1981 hade tio personer medforde luftning utan stank. Vidare fick man av och till stopp i uppgivit subjektiva besvar vid plantering av doppade plantor och rapporterat dessa plastkanalerna i a'nden pa svampklamman. Dylikt stopp kan ibland passera till yrkesmedicinska sektionen, Akademiska sjukhuset, Uppsala. Dessa besva'r ouppta'ckt pa grand av att plastslangarna var ett eller flera i form av irritation i nasa, ar m6rkfargade. Vidare skedde vid ett tillfa'lle ett misssnuva/nysningar, torrhetskansla i munnen, irriterad hud. varmekansla samt ode med att 'svampklamman kunde utsveda och domningar i ansikte och lappar. skruvas i halvt avtagbart skede varvid • De tio. samtliga man, rcmitterades for inget preparat frammatades. Dessutpm individual bcdomning till yrkesdcrmato- notcrades att svamparna vid behandling log. Atta kunde hudtestas med ritstest av storre mangd plantor per dag blev med ren permelrinsubstans lost i aceton slitna och trasiga och darfor ofta bchovde till 1 procent, och med 1-1,25-procentiga ersa'ttas. brukslosningar i sterilt vatten av Ipitox samt Ambush i 1-1,25-proccntiga bruks- Tabell II. Antal personer, samt andel med Ifisningar. Som positiv kontroll anvandes besvar relaterade till arbetet. histamin och som negativ koksalt. Dubbcl-bllnd-studle Vid Stora Kopparberg gjordes en intervjuundersokning angaende upplevda besva'r i 'samband med plantering av behandlade respektive obehandlade plantor. Detta tillgick si att personerna tog kodade sackar/kartonger med plantor och varken undersokningsledare eller plantore n hade vetskap om huruvida plantorna var behandlade eller ej. Salunda kom fern pcrsoner, utan fflregaende vetskap, att arbeta med planter doppade i Ipitox och fern personer att arbeta med obehandlade plantor. Da'rutover arbetade ytterligarc tolv personer med behandlade plantor. Vid arbetet bars vinylskyddshandskar, och handerna tvattades fare maltid. Delstudie Totala Personer Beantalet med svarsdeltagande besvfir frla Enkat 37 3 34 4 0 4 Exponeringsstudie svampklamma planteringskapp Hudtest 3 1 2 e 8 Exponeringsstudlc * Av de fyra som arbetat med svamp. kla'mma var en atopiker. Tre personer var icke-rdkare ocli en rdkare. Ingen uppgav nagra subjektiva besvar under arbetet, Betraffande urinsamlingen lamnade samtliga fyra prov efter avslutat arbete, medan endast en atfdljde instruktionen att ocksj lamna prov pafoljande morgon. Inget urinprov visade vardcn fiver detektionsgransen (0,5 /ig/ml). I de luftprov dar uppsamling skedde pa milliporfllter kunde inte nagon permetrin pavisas (under 0,001 mg/m3). Dar luftuppsamling skedde pi impingcrflaska aterfanns i 1 av 6 prov en luftkoncentration pa 0,0034/ig/ml (Tabi.ll Av de tre personer som arbetade med planteringskappen var tva icke-rOkarc och en rdkare. En person upplevde torrhet och sveda pa lapparna vid hantering av Ipitox-duschade plantor. Hon hade upplevt liknandc bcsva'r vid Ipitox-behandling foregaende var. En annan person som nu inte hade nagra besvar hade uppgivit sig (3 snuva av Sumicidin-behandlade plantor. Betraffande luftinsamlingen testades en av personerna med locket pi planteringskappen. upptejpat. Darvid registreradf s 0,004 mg/m3 p<:rmetrin i andningszoiu ,\ medan de dvriga tvi, som arbetade mid locket ordentligt nedfa'llt, inte hade nagra pavisbara ma'ngder i luften (< 0,001 mg/m3). I urinproven kunde icke aterfinnas nagra ma'tbara ma'ngder av permetrinmetaboliter«0,05/4g/ml). Hudtest De nu testade personerna var salunda sadana som angivit besva'r i samband med plantering av doppade plantor varen 1981. ; Ingen av de alia hade allergisk dispo-i- i tion, dvs barnastma, bbjveckseksem elk r sasongbunden hosnuva/konjunktivit. Fern : var rdkare och tre icke-rdkare. Snabbtes- , tet, ritstest, for Ambush, Ipitox och permetrin var negativt fdr samtliga. Dubbcl-bllnd-studle Av de 22 personer som deltog i forsOket i Stora Kopparberg var 16 icke-rdkare och sex rdkare. En av de personer (rdkare) som utan foregaende vetskap arbctadc med Ipitox-doppade plantor beskrev sveda i halsen och huvudvark pa kva'llcn efter arbetet. Ingen av de Ovriga 21 dell;1garna som arbetade med behandlade aspektive obehandlade plantor uppgav nagra besvar. 0 Dubbel-blindstudie doppade plantor 22 Diskussion 1 Den h3r redovisade enkatstudien r6rande subjektiva besvflr i samband med an- 21 Tabell III. Exponeringsstudie. Halten permetrin I luft, mg/m', och halten permetrlnmetabollt I urlnen, fig/ml Resultat Oelstudie Antal undersokta personer Preparat Luft Urin 38 pcrsoner sande in formular, varav en angav att han pa grund av astma inte deltog i planteringsarbetet. Fern personer hade atopisk benagenhct, dvs en hade astma,.cn hosnuva och tre tidigare cksem behandling 4 Ambush < 0,05 (n = !) Planteringskapp 3 Ipitox < 0,001 (n = 3) 0,0034 (n == 1) 0,004 (n = 1) 0,001 (n - 21 'Upptejpat lock. , < 0,05 (n = .It ___—• � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 027 Folder The folder containing the original item. 0388 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Source A related resource from which the described resource is derived Lakartidningen Date A point or period of time associated with an event in the lifecycle of the resource 1981 Title A name given to the resource High-dosage Treatment with Cytostatics in Acute Myeloid Leukemia Subject The topic of the resource health studies health monitoring ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 029 Folder The folder containing the original item. 0483 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Beljan, John R. Nelson S. Irey Wendell W. Kilgore Kazuo Kimura Raymond R. Suskind Jaroslav J. Vostal R. H. Wheater Description An account of the resource <strong>Corporate Author: </strong>American Medical Association, Council on Scientific Affairs, Advisory Panel on Toxic Substances Date A point or period of time associated with an event in the lifecycle of the resource October 1 1981 Title A name given to the resource The Health Effects of "Agent Orange" and Polychlorinated Dioxin Contaminants Subject The topic of the resource health studies industrial exposure human exposure veteran health and hygiene ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 030 Folder The folder containing the original item. 0503 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Bogen, Gilbert Source A related resource from which the described resource is derived Journal of the American Medical Association Date A point or period of time associated with an event in the lifecycle of the resource November 30 1979 Title A name given to the resource Letter to the Editor: Symptoms in Vietnam Veterans Exposed to Agent Orange Subject The topic of the resource health effects health studies ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/bb3b2e854afbbc1197cdafdddc181e61.pdf 6e9735a9c96a014fc47e12c23a1c99ff PDF Text Text Item ID Number 00578 Author Custis, Donald L Corporate Author Report/Article TltlB Typescript: Statement of Donald L. Curtis, M.D., Chief Medical Director, Department of Medicine and Surgery, Veterans Administration, Before the Subcommittee on Oversight and Investigations, Committee on Veterans' Affairs, House of Representatives, September 15,1982 Journal/Book Title Year Month/Day Color Number of Images DeSCrlptOII NotOS n 20 Alvin L Your| gfiled tnis item under the category "Human Exposure to Phenoxy Herbicides and TCDD" Tuesday, February 20, 2001 Page 578 of 680 �I. ; - i «PV ' u, - , > ..v?../.^J^T.of, , .,,, ' .' •. , DONALD L.CUSTIS.M.D., 1 1 . -., ' CHIEF MEDICAL DIRECTOR, T *V DEPARTMENT OF MEDICINE AND SURGERY { V ( , , * ir:^TER/^ ^^WAT!9N ^*> ^;-( , _ * ,v ^ f r '."-•,' ^BEFORE THE , t SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, COMMITTEE ON VETERANS'AFFAIRS HOUSE OF REPRESENTATIVES September 15, 1982 < I * > * » , / f 1 < r "t ', » * '1 t, *<t i* " ' t V ' * • > ' ' . * ' '*' '» .1 Mr. Chairman and Members of the Committee: f tv t"*, s Good morning. 1 » < '» •> *.» , v ' . On behalf of the Veterans Administration, we are pleased to have the Opportunity to appear before you today to provide an update on the status of both VA's Agent Orange-related activities and the Readjustment Counseling Program. We are continuing efforts to resolve the complex medical and scientific questions concerning Agent Orange. In the interim, we are providing medical care and treatment, as well as information to Vietnam veterans. We believe that a great deal of progress has been mode in both areas since we last appeared before this committee on May 6, 1981. Mr. Chairman, we are aware that both the Agent Orange issue and readjustment to civilian fife remain key concerns for many Vietnam veterans. A great deal still needs to be done to resolve both of these concerns. Let me reemphasize, however, that the Veterans Administration has never lost sight of the special needs of the Vietnam veteran. �2. \ V,, . *?fr Aoent Oronge Program T \rT* • l " * w ' ' *;/- . IT?- ; \ <;«v " , ^ ' * On June 30, 1982, Robert P. Nimmo, Administratpr approved a revised Department of Medicine and Surgery program of Agent Orangerelated activities. The most significant activity which was approved is a pilot study as a preliminary to the full epidemiological study provided for by Congress. Other major efforts included are the Vietnam veterans identical twin study, a mortality study, and specially-related research projects. Approval was also given for the establishment of the Agent Orange Projects Office within the Department of Medicine and Surgery. This office will coordinate and monitor a variety of epidemiological projects. Efforts are now underway to identify key epidemiologic staff who will be responsible for these efforts. The core staffing will consist of an Epidemiologist, Biostatistician, Statistical Programmer, Health Science Specialist for Quality Assurance, on Administrative Assistant and supporting clerical staff. In addition, approval was given for continuation and improvement of the Agent Orange Registry, chloracne activities, a follow-up to the literature analysis, a monograph series, establishment of a Vietnam service indicator in the Patient Treatment File (RTF), and a retrospective study of dioxins and furans in human adipose tissue. STATUS OF VA EPIDEMIOLOGY STUDY; The epidemiology protocol submitted to the VA by the UCLA School of Public Health on April 29, 1982, has now been reviewed by the VA Advisory Committee on Health-Related �3. Effects of Herbicides, the Agent Qronge Working Group (AOWG) and the Office of Technology Assessment. The protocol is currently being reviewed by a committee of the .Academy of Sciences (MAS). The VA has been advised that HAS is now in the jes of this review process. It |s expected that the report will be completed and > '' - , f\ forw.a/jted to. tjh$ Veterans Administration shortly* Following incorporation of the .yarjous ^eYlewers/ comments, we will solicit bids for a contract for the conduct of a pilot * * * » ' *-, study. We anticipate having that solicitation in place before this December. " i ' «u The purpose of the pilot.study w|U be to permit us to "fine-tune" the protocol for the conduct of the frjll-^cale epidemiology study which will study a population of approximately 18,000 veterans. The pilot study has become the focal point of recent activity by the VA, the Army Agent Orange Task Force (AAOTF) and the AOWG. < The AOWG has appointed a subcommittee of its Science Panel to establish procedures for cohort selection for the epidemiology pilot study. The VA has brought in bipstatistica) consultants to work with this subcommittee and with the AAOTF. The Subcommittee is now in the process of preparing its final report to the Science Panel. Health Care Tr« Veterans, Administration is implementing the medical core and treatment provisions of Public Low 97-72, the "Veterans' Health Care, Training, and Small Business Loan Act of 1^81." Shortly after the law was signed, interim guidelines for the implementation of » ' .. these provisions were issued to all VA health care facilities. Those guidelines were also '- . . •• . ' "-' • „ - ' • ' -i ' • ' , - • 'f- ' ' . . y published In in the Federal Register on December 5, 1981, to provide Vietnam veterans and the general public with the opportunity to comment. �. • . . . . . . . . . , . Under the provisions of the guidelines, each veteran who served in the Republic of • ' ' . . ' .' . <>.. ".'•.-' • • . . - . . • . - ; .'" ' • ' • , . : - , • • Vietnam and who requests VA medical care Is being provided a complete medical history, physical examination and appropriate diagnostic studies/When it is determined that a condition exists requiring treatment, the responsible staff physician makes a determination as to whether the condition resulted from a cause other than the specified exposure to Agent Orange. The guidelines include a description of those conditions which I determined cannot ordinarily be considered to be due to such exposure. • ' * .' . •: • ' . - . . • : 'i - - ' -' •• • • Ultimately, it is left to the treating physician to exercise professional judgment in determining whether the veteran should be provided care under this authority. Agent Orange Registry '• -• • • . , - • ' ' -:• ;••• ' • ' - : •>' : . ' • : • . • • ' . ft. .:• ' : .'• r. " : ':• Since the initiation of the Agent Orange Registry in 1978, approximately 91,000 veterans • • " • • - . . • • • ' f ', • have received an Agent Orange examination at VA health care facilities. The VA has provided approximately 20,000 follow-up examinations for Agent Orange. The basic registry process involving a comprehensive physical examination, completion of a questionnaire and informing the veteran of the results of the examination verbally and in writing, are continuing to be followed by all health care facilities. The monthly report, transmitted by VA health care facilities and compiled at VA Central Office, is still an effective tool in measuring the numbers of examinations (initial and follow-up) being performed at the facilities and the number of pending examinations. * . The4 Environmental Medicine Office is continuing to monitor the numbers of pending examinations to assure that the veteran is provided the Agent Orange examination and related treatment in a timely manner. Facilities reporting •Vjut-of-line" situations, that .:.'••• ' -., r •• . . -.SV' '.;• • .:. • r ' . ' - " ' '.• , is, facilities with examinations pending more than 30 days or having more than 50 . , ' ' . . ' • ' . • • * • * .-- ; ' • • - k •'»•.'• ' : •'•••• • • ; : ' • : • '•"•"'• .-;.^'< • .•• '••(•• examinations pending during any reporting period ore contacted by program officials at �5. V^A Central Office and directed to'take Immediate action to reduce the number of pending examinations to comply with Central Office guidelines. •ij^iSj,.^ i H i' 1 ^ t~ ** s £ i I* r ^- / 5 *** ' w ^5 t tsT^^j)*'^ £, { ij T** ' J$ ^ ~*** ** i, ' * * 'Improvements In our registry procedures will enable the VA to match Agent Orange Registry records with records of hospitalization in the Patient Treatment File (PTF) system so that correlations can be made regarding the types of diagnoses Vietnam V '» * ! « ' » ' • * f > «' s '« 1' ii»'l»'J* H ' ' " • !' veterans are fpresenting forf treatment at VA health care facilities. t » -si j f *' *A* The VA is cooperating with the Department of Defense with regard to Agent Orange examinations for active duty personnel. Instructions will be mailed to all VA health care facilities for processing an active duty service member's request for an examination and for processing the forms. The results from this examination will be entered into the Agent Orange Registry. Twins Study j\ " \" / < • < ' < • >' • • '. The VA has recently given approval for the development of a comprehensive protocol i that will involve studying identical twins. The proposed study would involve identical twin veterans where one twin served In Vietnam during the period of Herbicide Orange spraying and where the twin sibling did not serve in Southeast Asia. This study will be designed to investigate whether the current psychological and physical health of Vietnam veterans was adversely affected by their military experience in Vietnam. Veterans Administration researchers at our St. Louis VA Medical Center have proposed the study and ore currently developing the protocol. We would anticipate that If the protocol survives the scrutiny of appropriate scientific reviews, we will launch into the physical examinations of some 450 pairs of identical twins in late 1983 and should have an initial report of findings by October 1984. .. : .c T i, • . *.- • ' . i j > . ..••„• / • • : . - •" • .- • i •• ' . .• . . .•" i '• ..'-•• •: '.. �Vietnam. yeteranJAortality Studies • • • , . . . • < ••"••. '^^-t&ffi&S^ ":"' . ' "•'.'.• ' " A carefully-designed and well-executed mortality analysis of Vietnam" veterans will provide background to many questions raised by the Agent Orange exposure issue in particular as well as the possible health effects of service in Vietnam in general, the Vietnam Mortality Study is designed to analyze and compare cteatH rates arid cause-ofdeath profiles of veterans with service in Vietnam and comparable veterans with no service in Vietnam. The studies will use existing computer records to assemble a cohort of veterans and . ' . . - • • ' • ' • • "'"-. v",/;.•••• ' • ' ' : ; - • • • " '"*!'•••'•;.-j '•• ,. . •,. . -•(.•'•i-- ' ': , • ' : ; ' - • : : ••*, determine their mortality experience. It should be noted that the mortality studies will provide mortality information which may prove useful primarily in suggesting areas for further scientific study. These mortality studies will be conducted by researchers at the Veterans Administration Central Office in Washington, DC. The collection and coding of death certificates and the abstracting of military records will be done by VA contractors. We are currently evaluating submitted proposals and hope to sign contracts for these efforts shortly. It is anticipated that it will take approximately two years to complete the mortality studies. Retrospective Study of Dioxins and Furons in "Adipose Tissue of Vietnam-Era Veterans The Environmental Protection Agency has been collecting adipose tissue from the U.S. general population. This National Adipose Tissue Bank was initiated in 1968 and now contains specimens from approximately 6,000 individuals. Represented within this bank is adipose tissue from approximately 3dO males born between 1938 and 1952. It is estimated that �7. approximately 200 of these males may have served in the U.S. military during the ,'i&V&<'-iU^,'"Ti£l^ Vietnam"erei and that as many as 70 may have lervecl in Vietnam. . ~ : fef M%fi^^ ••'^'" •^'^•: "We are currently developing an agreement by which the VA would support an interogency iludy to be conducted at theJ^PA 6ioxin Laboratory in Bay St. Louis, Mississippi. This K^:!>!M?^ V*n^ ' - . - • '--'">;?"<^ ^•••'^('' will be a retrospective study of chlorinated aioxins and furans in human adipose tissue. The study is designed to establish 'background levels of 2, 3, 7, 8-TCDD in the U.S. male population. In addition, this study may serve as a means of determining whether service in the military and especially in Vietnam has had an effect on the levels of TCDD in the ^.J^'i ' - JM > , ! < , > « f?''V«, ' • * , * < " '»f i *> ' ' ' '"^ ' adipose tissue. if' „ \t r < i t ?. '«V * * ' ' V i , * I" •' ^v i » " ' " ' The proposed effort would involve a jointly-funded program between the VA and EPA to & £*_ 1 • f - y * * * 1 ! A 3 " i *.* ! i # ^ ^ develop the research protocol and appropriate sampling and analytical methods. The actual analyses of the human tissues will be costly and time consuming. Data should be forthcoming within two-three years. « ,» ^ < ••••• • .; ' •' ' ; • : • • • • Chloracne Activities The review of skin conditions to identify questionable cases which may be chloracne is •' • •'•-••':'••-:• ':,'•: '• .•'•: : i--> v 'v.'' : -'.';. ; • ' continuing. •'' ' .'•;• •.' , ." ' : . . •'•... Over 3,200 Rating Decision Sheets on skin condition claims have been reviewed by VA Central Office physicians. The medical records of questionable cases were reviewed by a dermatologist consultant at the Washington VA Medical Center who tentatively identified 12 cases requiring a further clinical review which will include a . • ; r': : ' : ' -•-' •• : ' v -••-.'••• • • • physical examination of those individuals. ••-.-. ' .. • I .>.. . • . . • • • • • . : • . < • ! : ( : • ' ; : - . t / V K - ''• We are now In the process of making arrangements for the physical examinations, •,i i ' ; • . ' » - • • : ' . . - - ' • ;•;•:'./ . ; - , ' : .-• including dermatology examinations, of these individuals at selected non-VA clinics. I r-:. ^.;-,;-:;- •;;£..;•;<*'^'.-^^V^/v^^U-' ^ ' J ^ v »^ .-•»:•-•:.: • }• • r.f-- ':.< ?'• •". . '•'•'• : 0, anticipate that these examinations will be conducted during October. >, •"••"..<. ,<' �8. •-• • ••>..-"•' •- "Tt '• '-,.'• , V i '% • }.- >• J t ;»•-< We intend to continue our review of Rating Decision Sheets provided by VA Central ' Office Compensation and Pension Service to determine possible chlorocne cases and recommend selected claimants for special dermatojogical examination. Additionally, we will review and analyze Agent Orange Registry data relating to types of skin conditions being reported by participants. -.- •• ••.-..•• ' ', * ' ij. i • i< < f ' ' I am confident that our current emphasis on chloracne-related activities will assist us in more effectively identifying and treating skin conditions which may be the result of exposure to Agent Orange. Vietnam Service Indicator for Patient Treatment File The Patient jreatment File (PTF) maintained by the Department of Medicine and Surgery has great potential for epidemiological research related to Vietnam veterans. A major problem with this automated, file is that there has been no entry to identify those veterans who actually served in Vietnam. .' • . " -s" The establishment of such an indicator, in most instances, will require a hand search of the individual veteran's service record. This would best be accomplished by a contract with an organization which has a proven record of expertise with this type of effort. ' ' " . " . ' \ We intend to conduct a study to determine the feasibility and cost of obtaining a V A - K - - . . . . . . . . • •- ; •-.•!•• , ., - ' . ' - • " , • . . • • • . - • . - . - • • • • ' • • • • • • • "• : ; . veteran's service history. Based upon the results obtained, we will then decide whether to obtain this information for all Vietnam-era veterans in the PTF. �Speciolly-Solicited Reseorch Activities *r* c-r— j ^ r i r~ ~ Medical Research Services has recently approved 10 new Agent Orange research studies f *" t •* that will investigate the impact on basic biological processes of low levels of exposure to Mfr ? * **T^ * * * ' . . - components of Agent Orange. Two other ongoing studies address these issues also. The Studies include analysis of the impact of Agent Orange components on: o Over cell function '" t, v I j -I f ii s jr. 0 ( f Skin cell chemistry relating to chloracne o * Neurobehavioral function ' •, t f * > « '«!, ' . -x V » " • ' The basis of the design( of each of these biological studies includes exposing a test ........ "' . ' *• i , biological system to one or more components of Agent Orange, and subsequently •3 • '••?*••.! . ; ' ; : ^ ;, - £*.••:'•:* •- ' ' * *"'• 'f.\::t^ ;'r' •••'• '.':. • , . . : . . , . . _ • measuring abnormalities of biological function. ~f\ -^ " - ' ; • . • • • • . . . . • • " ••'<-. : : ': •";'• ;"i.-!:^^;-,y V-' '.•.'•*' . i r . . . y ' v < - . , •.. •X^:.;{j,4;:>:.-- .--s ,; ; v/* -• ... ',,:?;;•,'',.;.-; ;.y>/. N j i : ^ :.-.;-v:: rn :•.• ..' • The chemicals used in these experiments which are the main component parts of Agent '• ''.'• ' '- • ' ' l ' * : ' • U. :••"'.'• V-",> •/"•!•»:•''«•" yV'-C-V;! • :.!Vi''.'>V '.-;. ' ,: ',' ? (• ':•:' : '•''•••'.'•l^..? ' ! ' • - • • . ; ' • ' ' < - . . „ ' .''"fi'v •'. v i* -<i '.^ Jl'*'!*,'* i'-. ' t •'. '. - ' '• " '' Orange are: 2.4-dichlorophenoxyacetic acid (2,4-D) and 2,4,5-trichiorophenoxyocetic " ; s- {. . .-' : * -i 'i .; f i -^ . ,. ; V-. ' 5 • * ^ , - ; , : • ^VU-i. 'i .^ . , . . . . acid (2,4,5,-T). In addition to these chemicals, Agent Orange (and some other herbicides used less frequently in Vietnam) contained varying amounts of a contaminant commonly referred to as TCDO (dioxin) which will also be a focus of studies to determine whether and how delayed toxicity is manifested after low-dose exposure. Such studies may provide clues for clinicians as to what medical tests would best identify delayed, toxic effects, if any, of exposure of veterans to herbicides in Vietnam. The biological systems thought to be affected by exposure to TCDD are: 6 Liver function; When animals are exposed to TCDD and related compounds, these chemicals are stored in the liver and produce acute liver damage. It ]' • . . ^- �10. would appear likely that any delayed harmful effects of exposure to low closes of »uch compounds would be manifested by subtle changes fn the biochemistry •«f the liver. Seven of the funded research studies will investigate the delayed impact of exposure to Agent Orange components and the contaminant TCDD on various aspects of liver cell functions in a variety of •'•'".-.• species. t' o ' ' , " ,- ' • ' , ,' • -.. . ' . • - - • -• ;, • • . ' .• •. . .' .. • . . .' • . • .. •. • . . •• -, . Skin: Chloracne is the one documented effect of low-dose exposure to Agent Orange in humans. One study will analyze the underlying biochemical events that lead to ch lor acne in a mouse model and in human tissue culture cells. o the nervous systems: Acute accidental poisoning with TCDD in man has led • j- ' •- • • • ' ? ' ' ' • ' • ' . " ' • • • •- '•• • • .' • .'•*•*"' • .' • ' r< . i . , . .' - ';j f to a variety of usually-acute neuromuscular abnormalities. Four studies will ; •.. V. • - • ; , , - , - • : • • ••' > i . , • . •• •' ' •'• • •'• , '. ' " *iiV : • ' ' • ; ' • • systematically investigate the effect of the components of Agent Orange on neuromuscular function, sleep and behavior in a variety of animal models. A new effort to solicit and support research on the special health problems facing Vietnam veterans has just begun. The Research and Development Office has sent forward to all VA medical facilities a solicitation for research studies dealing with disorders affecting Vietnam veterans and their families. It is anticipated that a significant number of new studies submitted in response to this solicitation will be supported in Fiscal Year 1983. • • - • - - • . • • > ' • . .. .- - - / : - i : Monograph Series - .-•. ' >,••• -•• "' .;«:. -:.-, ..,-. • ;•;.. • „ • ' • • ;, •• /• :/: • • . , . • * ' - . " ; • • , • Funding has been provided during FY 1982 for the preparation of a monograph series designed to provide useful scientific information on environmental factors that may have affected the'health of military personnel serving in Vietnam. �II. -&#!^^^ ore planned on the following subjects: Monographs :^/ri;* •'wf1^^ Literoture Anolysis • -|V.i.' :,. . chloracne, birth defects and genetic ' ../; ' --;.-N.-:-••--t^:. .... .::•.., . ',-v;v. ' ' v:• ^l^^fc^^^V^^ ;.«:4^;-;;utf,^*^feM]tt^:^ ..,.. : Mr. Chairman, as you may know, the comprehensive literature review of worldwide scientific literature on Agent 6range and other phenoxy herbicides used in Vietnam has *'•:•'."'', • ;•»' . • ' • ' • ' • ' - ' - - . . • • • . been completed in accordance with the provisions of Public Law 96-151, ... ' .-., . ;,. .. •.. . ,. , - • . '.',•;..•: .-<*..• - v.-',,..-...'., •;•''; - • : . .. , .-,, . . . . . . . We have .!••.; ' distributed this two-volume report (which includes an annotated bibliography and analysis of1,200i scientific papers)^widelyWithin imeVA. Copies have also been provided .to rnembers of the White-House established Agent Orange Working Group, the Advisory Committee on Health-Related Effects of Herbicides, the National Academy of Sciences, the Office of Technology Assessment, the Departments of Agriculture and Defense, Surgeon General of the U.S. Air Force, Library of Congress, the Centers for Disease Control and other individuals, organizations, and scientific research groups. The successful completion of this review represents a step forward on the Jong road to understanding the complex health issues related to the use of herbicides. It will undoubtedly serve as an invaluable scientific resource which will assist scientists and others in identifying areas suitable for additional research. We jntend to periodically update this report and to augment it with a detailed critical assessment of all publications addressing herbicide exposure with particular emphasis on health consequences in humans. It is estimated that about 400 publications have appeared since October 1981. A critical review of these recent reports is needed in -•,•••• •.•;,!'.. • • :*> .:.-•=..-.'-, : --•:. • :•• ••-:,,".^;„. •!:^f,'.-.. : --:--r-' -• •• ' , ' order to keep this effort current. The Veterans Administration will take necessary steps to ensure that the literature review and analysis remains as current as possible. �12. Armed Forces Institute of Pathology (AFIP) The Veterans Administration Is continuing to cooperate with the Armed Forces Institute of Pathology in providing biopsy and autopsy materials for analysis to the Institute. This special registry was established in 1978 with the purpose of analyzing tissue samples to determine what diseases Vietnam veterans are suffering from, as reflected in biopsies or The VA has repeatedly emphasized the importance of the AFIP Registry and will continue to urge VA health care facilities to send pathological material obtained from any Vietnam veteran. . ; v: Education Activities Mr. Chairman, our environmental physicians, as Agent Orange coordinators at our major VA health care facilities, remain the key link in examining and advising the veteran concerned about exposure to Agent Orange. In order to ensure that these health care staff remain completely abreast of the latest developments, nationwide conference calls ore held on a regular basis. When required, special conference calls are scheduled on significant developments requiring their immediate attention. In addition to the conference calls, relevant Agent Orange-related literature is periodically sent to the immediate attention of environmental physicians. Staff support within the Environmental Medicine Office is available to assist in the explanation of .specific documents. or to answer questions which may be raised by the information received from VA Central Office. �13. Environmental physicians ore encouraged to participate in important scientific meetings : '• " --• , - * • • I<in Ag«nt Orange and other environmental substances in order to keep abreast of scientific «nd medical developments. Members of our own VA Central Office staff * i played a key role In the planning and organizing of an "International Symposium on ' ,, . - < ' " * •. , .Chlorinated Dioxins and Related Compounds" which was held in Arlington, Virginia, on October 25-29, 1981. On October 12-1 A, 1982, Or. Barclay M. Shepard, my special assistant, and Dr. Alvin L. Young will actively participate in the "3rd International t * Symposium on Chlorinated Dioxins and Related Compounds" which will be held in Salzburg, Austria. ) hove been advised that several of our environmental physicians are /also planning to attend. Through such participation I am confident that our health care 'ftaff will remain professionally current with the latest findings on the short and longrange effects of Agent Orange and other environmental substances. VA Public information Activities As part of our effort to inform Vietnam veterans, their families, and other concerned individuals and organizations about Agent Orange and the assistance provided by the VA, we produced and distributed to all VA field stations a videotape entitled "Agent Orange: '< A Search for Answers." '* • , While a recent internal survey indicated that many thousands of people have viewed the program on television or in numerous groups of individual showings, we are encouraging grepter use of the film. ' : ' ' We are very pleased to report that this videotape has received considerable acclaim from critics. The Health Education Communication Association and the Network for Continuing Medical Education presented an award of merit to the VA for Outstanding �14. i t, . . - , . , • . : , . ' ; • ,.'•;••• /.',•• . , -••• . ' ' • " ' •••'. ochievement in the use of television for education in the health sciences." The International Television Association (ITVA) awarded its Golden Reel of Excellence for the vltteotape's "highly-effective form of communication, which helped Ifie user ,>;;l>i';•• ,: • ' •''•••. • ••'.\ . ..:•••: ..• •'•'•>>.'.w ft)$-.;::, •';''•:i.?W^'ify^.-lc-1'; •^i~::*';p-^*i^>\}•:*£,•: f ';"• ;•:-. • organization better achieve its stated goals." the program also was cited by ITVA for • • .-. : • . • • ' • • • • •:-,•• . ' • . : -;;:.,- ''fe v -!i;-v;-fjK^:i^^^':^ ; i.-3. : ';^ ^ : |pv»v v !^».••;>:•'/•; i;.i^l;/,.;,< • ' . : . creativity, innovative techniques, and high-production value. In addition, the program also received an Emmy Award from the National Academy of television Arts and Sciences. We are delighted by this recognition and encourage all interested individuals to view this program. * The VA takes seriously its obligation to keep veterans informed about Agent Orange. We have also pursued other avenues to provide information and education to concerned Vietnam veterans and their families and VA employees on matters related to Agent Orange. . Early this year, an automated mailing list was developed from the Agent Orange Registry. In June, letters were sent to these veterans along with the first two of a new series of printed information material on Agent Orange. One of these pamphlets was devoted primarily to Public Law 97-72. A third pamphlet has been issued and a fourth is ,-, • .. . i, . :. - . , .. . -<:•...... - • ' ;.-. ••;.:..•:•:; . - ....-• , , • • ••-< ' , . - . . . - . . . ' -•• r • • . .-=.-. in production. VA officials have participated in public seminars, news media interviews and other public forums dealing with the subject of Agent Orange. 5,. ;/. ..-• ' • • " ' : . . , • : • • • < • ; ' • • • :;c;.-x •' • •'••... •''-• • .'.' • • • • • ;.?; • • "':-'-•. •+-*\v • • . • ' • - <•;,.', VA Liaison with State Agent Orange Activities At the present time, 18 states have initiated programs directly related to the Agent Orange issue. The VA is continuing its efforts to maintain an effective, ongoing �15. J » ' , ,,• , " • . . ' ; . ' • relationship with each of these state programs. One of the prime responsibilities of our Agent Orange Research and Education Office is to insure that current and accurate information regarding VA Agent' Orange-related activities is disseminated on a timely * * * <, ' '] ' ' 1 ' r -t " . ' ' • ' • '•' basis to the various states,' as well as to veteran service organizations, government agencies, and interested parties. We consider }t to be an essential part of our program to * - "' " I • ••" ; • insure that the veteran population as a whole, and those who serve them at all levels, are fully Informed both with regard to the current body of knowledge regarding the possible adverse effects of dioxins, as well as the status of VA Agent Orange programs. V" - ': ;' " ' i'V* ' ' ^ .1 ,""'.'' To this end, the VA has provided the states with copies of all pertinent Agent Orange materials and we have extended to officials from all of these states an open invitation to attend the VA Advisory Committee meetings. Several of the states sent delegations to ' . ' • • , - ' ' , • . ' ' ' ' / ' . " . . . ' • •" . . -i, • the meeting held on August 31. The efforts are of a continuous nature and are beneficial to all concerned parties. As new states become involved in the Agent Orange issue, VA will include them in its information exchange program. White House Agent Orange Working Group (AOWG) We are pleased to report that the Veterans Administration is continuing to play an active role in the White House Agent Orange Working Group and its Science Panel. This committee was established in July 1981 when the Interogency Group to Study the Possible Long-Term Health Effects of Pnenoxy Herbicides and Contaminants was expanded and elevated in status to the Cabinet Council level. �$"' 16. .v *>, The AOWG brings together policy officials and scientists from throughout the federal : • r _, " >;'.,,, •." , . - • - r • " - . . • ' .'. *-*.-.- . . - • • • . . : -.'•• •-•-v.%»*i. . :..;'"'<• •',;••'',•• ;...•,>•', ,.v >"'•'; :" ••" • • ', ' ; ,.• • •••"•• ' '" establishment to identify ongoing research activities on Agent Orange and related (*• " matters and to develop and organize the means to carry out additional needed scientific \ - research. £ * '> > • • • • •'-••'• ••••• •'/•>»• :•:•;-: ; :V r -i;y :••.;•>. K .-.i:-'7'-:%tf^H-:f:/ v,;. ':• -V^ i'. •:. v^,...:. ,1,-,^ ,-U-' . ^ , j v . i ;, ^ 4.,t!,s.; ' The Department of Health and Human Services (DHHS) is the lead agency in the working / group. • ' •• - . • . • • • • • • • : . , . . . - \ ; . . • ' . • - ' • • • . . : -/->,,^,,'f'- . • ; . • ' . . : = . ;..- :•,., I',.,,--;.:,.., i.! ,- y - ,. : In addition to DHHS and VA, the AOWG includes representatives from the Departments of Defense, Agriculture, and Labor, Environmental Protection Agency, • •• •' •'• • . ' •••'•- • ; • • : • : • •••::.'=• ' : • . . ' . •^ • Office of Management and Budget, Council of Economic Advisors, Office of Science and Technology and Office of Policy Development. The AOWG has been very helpful to the VA in the review of our planned epidemiological study, mortality study, and other important research efforts. Through the AOWG mechanism, the VA also has been able to contribute to the success of Agent Orange research efforts conducted or sponsored by other federal departments and agencies. The more important of these research efforts are the U.S. Air Force's "Operation Ranch Hand" study and the Centers for Disease Control's Birth Defects Study. We view our participation as vital to the scientific process and as fully consistent with > • • • • . . ••>.>-:•,.-,..••. , , .-•:,•,.•,, ,-,. ;.;.,:•:,,-,. .•.',.:;-..,,*•.•••?>•• •..;:.1,^., v -, , ( . ••, •.-•:;... u: ,...,....,. the President's goal of ensuring "... that the full resources of the federal government . .-,,. .. ,.„,.,..;-x > •:.i,r-: *•: ' ' - y ...!.ys. .•-. . ; are available to support the working group's continuing efforts." i. Advisory Committee on Health-Related Effects of Herbicides This committee, established in 1979, continues to meet quarterly at VA Central Office for the purpose of assembling and analyzing information which the VA needs to formulate medical policy and procedures on"the complex questions surrounding veterans' herbicide exposure. �17. During recent meetings the committee has discu&sed the VA epidemiological study and herbicide Ijterdture review,' the VA-*olicited in-house research program regarding Agent 1 /• ^ , iilj Orange and Agent Blue, the VA mortality study, international dioxin symposiums, the Air Force t^ealth'Study, the CDC Birth Defects &udy, the proposed VA Twin Study/the * * ' * , t r AFIP Agent Orange' ftetfistry, the VA rVioribg/aph series, and many'btheir-research f- *-, ' . activities and rrtottersdf concern to Vietnam veterans dnd scientists searching for answers to the (difficult qUeirfions1 raised oi>obt'the possible human health effects of herbicides. "'>•• : ':'':';".>-v,-;'1, ^^v^-i^^'^^^^'^f^^V^^Sv!^?;'-/.1''' • ; . • • " ' ' : ; ' : - ' • ' ! • ;••• "•< '- ; .-'-'^ • ' • " : ""; ' %- • The committee 'has been particularly helpful in advising the VA on the literature review and the epidemiological study. The literature review, published October 1981, was the subject of several sessions and considerable time and attention have been devoted to a critique of the proposed epidemiological study design. Verbatim transcripts are prepared and made available to appropriate government offices and interested organizations and individuals. A copy of each transcript also is sent to all environmental physicians. ; ;:; Policy Coordinating Committee In recognition of the importance of the Agent Orange issue, the Administrator has reorganized and elevated in status the Policy Coordinating Committee (PCC) which was * * • . . . . . ' thCjAgency's central coordinating point for Agent-Orange related activities. The PCC develops policy for review and approval by the Administrator. It now is composed of the top leadership of the major departments and staff offices within the VA. Mr. Everett Alvarez, Jr., Deputy Administrator, chairs the PCC. �18. I wish to conclude this port of my testimony on Agent Orange, Mr. Chairman, by again expressing the total commitment of the Veterans Administration to attempting to resolve the many issues relating to Agent Orange. Although there is no way that we, or anyone, can guarantee that ultimate and conclusive answers will be found to the extremely-complex medical and scientific issues stemming from the use of the defoliant Agent Orange in Vietnam, nevertheless, we will continue to vigorously pursue the search for those answers. These efforts will center not only on our own research initiatives, but will be closely interfaced with the intensive research now underway by other federal, public and private institutions. Readjustment Counseling The Vietnam-era Veterans Readjustment Counseling Program has seen a number of important developments in recent months. In January, the Veterans Administration vested responsibility for this program in a new independent professional service—the Readjustment Counseling Service—and established that service on the same administrative level as Medical, Surgical, Nursing, Prosthetics, etc. A new program director was appointed by the Administrator of Veterans Affairs on February 10, 1982, following an intensive and thoughtful search and selection process. The±new Director of the Readjustment Counseling Service, psychiatrist, Arthur S. Blank, Jr., M.D., too Vietnam veteran and has been psychiatric consultant to the program since its earliest planning stages in 1979. �19. A^third leadership jnitjative ^was taken on Jun? |f, 198?, when a new position was created, C^hief pf^CpMn^eling Services, andean «*per4t clinician Dr. Raymond M. Scurfield from the Brentwood VA Medical Center was hired for this position. w Underscoring the significance » the^., A^n^jr^is^rator attaches to _the Readjustment / rj Counseling Program Is ;|he establishment |n November 1981 of a high-level Agency wide ' °" < i stee/ing commijtee tp.monitpr the^program, , , j-f ^ Improving the management. and^prganlzatjpn. :of the Vet Center Program has been one of our top priorities. In addition to augmenting our Central Office program management group, we have taken steps to strengthen the offices of pur six Regional Coordinators who oyers.ee. Vet Center operations in tl)eir .respective regions. During the developmental phase of the program, each of these important offices was staffed by a Regional Coordinator and a single secretary. Each Regional Office now has an Assistant Coordinator for Administrative Services, and we are further strengthening the Regional Coordinators' staffs with the appointment of an Assistant Coordinator for Clinical Services and an additionalI secretary. From an organizational standpoint, the most important development of recent months has been the publication of a new program circular, which clarifies lines of authority and responsibility. It contains several key elements: ~a. The responsibilities of the Director and the Readjustment Counseling Service ;.•.:../ ' • . . ' • . • ' • ' • ' • . - : • ' ' , • :•*'•' '"'•.•'• '• ' " .- • .;• •'.••'•'.". •- .-• • ... . •;.'..".••,.«: ."..:.. Staff In Central Office for overall supervision and management of the program are . spelled out. The Director and his staff have direct operational control of the Vet Center system through the Regional Coordinators and, within Central Office, ,„ report to the Deputy ACMD for Professional Services and to the Chief Medical Director through the Associate Deputy Chief Medical Director. �20. b. The responsibilities of the Regional Coordinator's staff are also clarified. We have established clear lines of authority and responsibility from Vet Centers to the . : • ' 'V ;•-• . :,-. ••^vi^'-,-.^.. • Regional Coordinator's staff to the Readjustment Counseling Service in Central Office. The Regional Coordinators are responsible for selection and all supervision , of the Team Leaders, and the program director is responsible for selection and all supervision of the Regional Coordinators. We have also spelled out the relationship (. • • $ * " > " " - ' '•- ^ ' between Vet Centers and their local VA Medical Center parent facilities. The : . •• • . ' • • - ; - . ..." '• -: •':"' •i •;:'. > . "••;]'.•?•'. V •;•'•'. •,'• •' • circular directs that the parent VA medical center is responsible for providing the Vet Center all required support services. On professional matters, the medical center's role with respect to the Vet Center operations is to be consultative and collaborative only. ; ' ' 'TV ' . •: . ' . . . . ' . . • \- ' ; ' ' • • ' '•• , . .. ..'''.- -•'. ' '. :,.' - ;• . . . . . As part of our reconstituting of the management and organization of the readjustment counseling program, we have instituted financial and accounting procedures which track all program funds and maintain their earmarked character at the local level. 1 '• • •• ''• ' * . . ' • ••' ' " • ' • ' , • • ' • ' ' ,• • ' • , i ' ' t * ' ' '• ' • . . ' ':• . * • • ' • " ' .'*• . ' • ' > - ' , ' . ' •' .• : • -. . ' *• . • " . " . . - . " " As you know, Mr. Chairman, we have also established a mechanism to contract with private sector providers to furnish readjustment counseling services to Vietnam-era - ' '. ^ ' . . . • ' ' ' • • -• • ~ • . . . veterans who do not have access to one of our Vet Centers. We are using a decentralized model with a contracting committee at each of 122 medical centers. The contracting committee includes two members of a Vet Center staff in each instance. As of August 31, over 300 contracts had been awarded. We are currently evaluating the quality and effectivenss of this new mode of service delivery. £ " • • ' . _ _ That concludes my statement, Mr. Chairman. I will be pleased to answer any questions you or members of the committee may have. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 031 Folder The folder containing the original item. 0578 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Custis, Donald L. Title A name given to the resource Typescript: Statement of Donald L. Curtis, M.D., Chief Medical Director, Department of Medicine and Surgery, Veterans Administration, Before the Subcommittee on Oversight and Investigations, Committee on Veterans' Affairs, House of Representatives, Septe Subject The topic of the resource VA Agent Orange Registry health studies AOWG ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/bcc6c17157f0a97a565050a554e38d09.pdf 5eb7456a98e018827f84bdc312ff1a75 PDF Text Text Item ID Number °0589 Author Davis, Miriam Corporate Author Tne Llbrar y of Congress Congressional Research Servic Report/Article TltlO Agent Orange: Veterans' Complaints and Studies of Health Effects, Issue Brief Number IB83043 Journal/Book Title Yeer Month/Day Color March 3 n Number of Images 19 DeSCrlptOU NOtOS Alvin L. Young filed this item under the category "Human Exposure to Phenoxy Herbicides and TCDD" Tuesday, February 20, 2001 Page 589 of 680 ��AGENT ORANGE: VETERANS' COMPLAINTS AND STUDIES OF HEALTH EFFECTS ISSUE BRIEF NUMBER IB83043 AUTHOR: Miriam Davis Environmental Health Fellow Michael Simpson Science Policy Research Division THE LIBRARY OF CONGRESS CONGRESSIONAL RESEARCH SERVICE MAJOR ISSUES SYSTEM DATE ORIGINATED 03/03/83 DATE UPDATED 03/03/83 FOR ADDITIONAL INFORMATION CALL 287-5700 0304 �CRS- 1 IB83043 UPDATE-03/03/83 I ISSUE DEFINITION From 1962 to 1971 the United States Air Force (USAF) sprayed various herbicides (chemicals that kill plants) in South Vietnam. The purpose of the spraying was to defoliate jungle growth and to destroy enemy crops. The most extensively used of these herbicide mixtures was known as Agent Orange, which is an equal mix of two common herbicides called 2,4,5-T and 2,4-D (2,4,5-trichlorophenoxyacetic acid and 2,4-dichlorophenoxyacetic acid). A contaminating chemical present in the mixture in small amounts was TCDD (2 , 3 , 7 , 8-tetrachlorodibenzo-para-dioxin) , or simply "dioxin." Dioxin is a contaminant produ-ced in the manufacture of 2,4,5-T. Its toxic effects to some laboratory animals are well known, yet its effects on humans are not fully understood. Since 1977, veterans have attributed a number of illnesses to Agent Orange exposure, including skin conditions, cancer, fatigue, nervousness, numbness in the extremities, vision and hearing impairments, birth defects in children, and other ailments. Veterans have urged the Veterans Administration (VA) to provide for medical treatment of these disorders and many have filed for disability compensation. Under P.L. 97-72, the Veterans' Health Care, Training, and Small Business Loan Act of 1981, Congress directed the VA to furnish medical care to Vietnam veterans, irrespective of age and financial status, for any condition which might possibly have resulted from exposure to Agent Orange. However, disability compensation for the veterans' illnesses has been denied unless it can be shown that the disabling condition began during the period of service. This criterion of "service connection" effectively denies claims for any latent disorder arising from military service. Until a rigorous scientific link between Agent Orange exposure and the health problems of the veterans can be established, the Veterans Administration will probably continue to deny the majority of veterans' requests for disability compensation. The VA and other Federal agencies are sponsoring a variety of research efforts to investigate the connection between Agent Orange and veterans' health problems. Recent congressional interest has focused on the transfer of responsibility from the VA to the Centers for Disease Control for the legislatively mandated epidemiology study of Vietnam veterans' health problems. The following questions continue to surround the debate effects of exposure to Agent Orange: over -- What are the adverse health effects of Agent Orange, and what studies are being conducted to answer this question? -- How much and what kind of scientific evidence is required to prove the right to disability compensation for _the veterans? -- On whom does the burden of proof lie to establish the link between Agent Orange exposure and adverse health effects? the health �CRS- 2 — IB83043 UPDATE-03/03/83' What constitutes fair treatment of the veteran until the scientific studies are concluded? BACKGROUND AND POLICY ANALYSIS History The USAF operated its herbicide spraying program in South Vietnam until the late 1960s when the National Cancer Institute released animal studies which showed that the herbicide 2,4,5-T caused birth defects in mice. At the same time, newspapers in Vietnam began to report health problems, including birth defects, in rural populations which had been exposed to herbicides. As the USAF was winding down its herbicide spraying program, it was also recognized that the military supplies of 2,4,5,-T contained amounts of dioxin suspected of being hazardous. The dioxin, which occurs as'a contaminant in the manufacture of 2,4,5-T, has been found to be highly toxic to animals. In fact, the birth defects previously attributed to 2,4,5-T exposure are now thought possibly to be related to the contaminating dioxins. The average levels of dioxin in the military Agent Orange were about 2 ppm. There were even greater concentrations of dioxin in other military herbicides less frequently used in South Vietnam: approximately 32.8 ppm in Agent Purple, and 65.6 ppm in Agents Pink and Green. In October 1969, the Air Force first restricted the use of Agent Orange to areas remote from populations; then it stopped all airplane spraying of Agent Orange in early 1970'and all helicopter spraying of Agent Orange by 1971. All remaining Agent Orange stocks were gathered and stored at naval facilities in either Gulfport, Mississippi, or Johnston Island in the Pacific until they were incinerated at sea in 1977 during the PACER HO project. The total amount of herbicides sprayed in South Vietnam from January 1962 to February 1971 was about 107 million pounds, according to a USAF report. Approximately 276,000 gallons of Agents Green, Pink, and Purple were sprayed in South Vietnam prior to 1965 when they were replaced by Agent Orange. Approximately 11 million gallons of Agent Orange were then sprayed in South Vietnam -- making it the most widely used herbicide of the war. Ninety percent of Agent Orange was sprayed on 2.9 million acres of inland forests and mangrove forests for defoliation, 8% was sprayed on enemy crops for crop destruction, and the remaining 2% was sprayed around base perimeters, cache sites, waterways, and communication lines. The Department of Defense initially maintained that only a limited number of U.S. military personnel could be positively identified as having been exposed to Agent Orange i'n South Vietnam (i.e., the crews of aircraft that were used to spray herbicides). However, following the publication of a 1979 General Accounting Office (GAO) report documenting ground troop exposure, the DoD has acknowledged that greater numbers of ground troops were exposed to Agent Orange through the USAF spraying program. Most recently, the DoD has attempted to arrive at an exposure index for individual ground troops. The American Medical Association has reported that about -2.4 million Vietnam veterans may have been exposed to herbicides. This figure includes ground troops, 1,200 flight crewmen who were responsible for the spraying under Operation RANCH HAND, and 200 U.S civilians who were involved in destroying the excess quantities of Agent Orange at sea. Details about U.S. personnel exposures are presented in the following section. �CRS- 3 IB83043 UPDATE-03/03/83 V Following reports of various health problems in some 'Vietnam ^veterans widespread concern about the possible health effects of Agent Orange was expressed. Many veterans have filed claims for disability compensation with the VA, basing their claims on Agent Orange effects. In 1979, a group of veterans initiated a class action suit against herbicide manufacturers for negligence and product liability. The manufacturers include Dow Chemical, Monsanto, Hercules, Diamond Shamrock, and Thompson-Hayward. This litigation is still in progress depending, in part, on the outcome of federally sponsored studies of the health effects of Agent Orange. Chemical manufacturers filed a third-party suit in 1980 against the U.S. Government that was later dismissed by a New York Federal District Court. Personnel Exposed to Herbicides. The early trials that were conducted in South Vietnam to improve aircraft spray systems were performed by the USAF Special Aerial Spray Flight Division at Langley Air Force Base, Virginia. During late 1962 and early 1963, the Crops Division at Fort" Detrick and the USAF Armament Laboratory at Eglin Air Force Base, Florida, were also involved in efforts to improve spray system components in support of Operation RANCH HAND. Most of the personnel involved in the actual handling of herbicide drums were Vietnamese. However, a USAF flight mechanic or crew chief was responsible for ensuring that each aircraft was properly loaded and that the spray systems were functional. Each herbicide aircrew consisted of a pilot and copilot, a flight mechanic, and a spray unit. The aircrews were frequently joined by South Vietnamese and U.S. observers. As noted in a USAF report: "within the aircraft, it was not uncommon to have herbicide leakage from around the numerous hose connections joining the spray tank and pumps with the wing and aft spray booms. In hot weather, the odor of herbicide within the aircraft was decidedly noticeable" (Young et ai., 1978: 1-18). It .is also suspected that, due to destruction of the tanks by enemy fire, crew members were acutely exposed to herbicides. In an effort to determine which ground units were'exposed to Agent Orange after it had been deposited on the ground, the Army Agent Orange Task Force and the American Cancer Society are attempting independently to correlate ground unit location with the location of aerial spraying missions. The USAF has data on 6,542 herbicide spraying missions that took place between August 1965 and February 1971 on its HERBS computer tape. These data were compiled on a mission-by-mission basis from reports and files in various offices in the U.S. and South Vietnam. After evaluating the HERBS data in a 1974 report, the National Academy of Sciences (NAS) concluded that the data accounted for approximately 86% of all herbicide operations in South Vietnam, and that "despite certain recognized deficiencies," the HERBS tape is "areliable source for an assessment of the major part of the herbicide operation in South Vietnam" and "is the best and in fact the only available comprehensive computation of the major part of the herbicide operations conducted in the Vietnam war." Since this NAS evaluation, the Army Agent Orange Task Force has been in the process of expanding the scope of the HERBS data to incorporate other herbicide sprays -- including perimeter base spraying and any unplanned dumping of herbicides from U.S. aircraft' that were under enemy attack. Despite this relative confidence in the location of the aerial and some ground spraying missions, it is difficult to determine which particular ground troops in. a given location were actually exposed and to what extent they were exposed. Although aerial spraying apparatus was' designed to �CRS- 4 IB83043 UPDATE-03/03/83 deliver the herbicide in a specified manner to reduce dispersion, no such standardized equipment was used for perimeter base spraying or other non-aerial delivery modes. Furthermore, additional troops may have been exposed in areas for which military records are incomplete. For example, not all information is available on helicopter operations flown by the Vietnamese Air Force before 1968. Thus, attempts to model the conditions of exposure in order to determine individual or group exposure levels are jeopardized by the lack of verifiable exposure information. When the DoD suspended all use of Agent Orange in South Vietnam, the USAF was 'left with an inventory of 2.22 million gallons in two locations, in Vietnam and in Gulfport, Mississippi. In April 1972, the stocks in South Vietnam were transported to Johnston Island in the Pacific for storage. Problems began to arise in both U.S and Pacific locations concerning leakage from the drums. After exploring a number of options, the USAF decided to dispose of the Agent Orange by burning it at high temperatures at sea. This operation was performed in 1977 with permission from the EP'A. About 110 USAF personnel from the Air Force Logistics command and about 100 civilian employees hired by a contractor were involved in the destruction process. Environmental monitoring of the transfer operations was performed by members of the USAF Occupational and Environmental Health Laboratory. Extensive environmental monitoring of the test incineration procedures was performed. Certain physical parameters of the actual incineration process were monitored. Physical' examinations of personnel involved in the actual incineration procedures, administered both before and after these procedures, revealed no adverse health effects. Health Effects of Dioxin and Phenoxyherbicides There are as yet no conclusive scientific studies on the long-term human health effects of Agent Orange exposure. In their absence, an understanding of health effects must rely on animal and/or human occupational exposure studies of dioxin and phenoxyherbicides. The following paragraph summarizes what is known about the health effects of these constituents of Agent Orange. Workers exposed to high concentrations of dioxin and/or 2,4,5-T (as well as other chemicals) are commonly found to have a painful skin condition known as chloracne. Chloracne can appear weeks to months after initial exposure and in some cases persists up to many years after exposure. Chloracne, however, can result from exposure to other chlorinated compounds besides 2,4,5-T. Studies of exposed workers have indicated a variety of other health problems; yet, there is not enough information at this time to establish a cause and effect relationship between phenoxyherbicides and these disorders. Soft-tissue sarcoma, a form of 'cance.r/ has been reported among Swedish workers who were exposed to phenoxyherbicides. Reports from a variety of sources associate dioxin and herbicide exposure with stomach cancer, neuromuscular weakness, liver enlargement, and liver enzyme abnormalities. Birth defects were first reported in South Vietnamese refugees living in North Vietnam, but, due to the difficulty of conducting studies in a war-torn country, the research on these reports was widely believed to be improperly executed. In animal studies, only certain strains of pregnant mice exposed to dioxin show fetotoxicity and birth defects in offspring. Exposed male mice do not have deformed offspring. Current Use. The EPA has registered 2,4-D for widespread domestic use on such crops as corn, grain, and sugar cane, as well as on non-crop areas; 2,4,5-T is currently used on rangelands, rice fields, and industrial vegetation sites, whereas approval for its other domestic uses -- forests, �CRS- 5 IB83043 UPDATE-03/03/83 rights-of-way, pastures' -- was suspended by the EPA in 1978. registered use of '2,4,5-T depends on negotiations that began in 1979 Dow Chemical and the EPA. Future between Herbicides 2,4,5-T and 2,4-D are commercially available either alone or in combination. The combination mixture (under Dow's Trademark, Esteron) differs from Agent Orange primarily in the level of dioxin. Existing Dow inventories of 2,4,5-T contain less than 0.1 parts per million (ppm) dioxin, whereas previous formulations of 2,4,5-T used in Agent Orange contained about 2 ppm dioxin. Although standards for dioxin levels in 2,4,5-T have not been officially set by the EPA, the EPA's Science Advisory Committee recommended in 1971 a level of 0.1 ppm. Veterans' Complaints and Veterans Administration Efforts Veterans who believe they have been exposed to Agent Orange have complained of a variety of illnesses for which they seek 'medical treatment and disability compensation. These illnesses include: skin conditions, cancers, nervousness, numbness in extremities, vision and/or hearing impairments, birth defects in their offspring, and reduced libido. Veterans have also complained about the paucity of scientific information available on the health effects of Agent Orange and about the sluggishness with which the VA has responded to their concerns. Specifically, the General Accounting Office (GAO) has recently reported that over half of the veterans responding to their questionnaire were dissatisfied with the amount of information they had received from the VA about Agent Orange. To fill the perceived information gap, various State 'governments, including New York and New Jersey, have attempted to disseminate information on Agent Orange to State veterans. < The VA maintains that it outset by initiating health exposed and by implementing description of the research has responded to veterans' concerns from the programs to identify veterans who may have been research projects on health effects. A detailed projects is provided later in this brief. Since 1978 the VA has provided a physical examination for Vietnam veterans who thought they were exposed to Agent Orange. The VA maintains a registry of all the veterans who have come to VA hospitals and health care facilities for the exam. The registry also contains information collected during the examination. As of Dec. 1, 1982, 101,721 veterans had received the initial exam, and about 80% of the records had been coded into the computer. The idea behind the registry is to determine whether veterans have a higher incidence of particular diseases. GAO auditors have investigated the effectiveness of the v Agent Orange examination program. The findings are summarized in an October 1982 report, "The V A ' s Agent Orange Examination Program: Actions Needed To More Effectively Address Veterans' Health Concerns." The report is 'critical of the exam for being incomplete, poorly designed, and for being administered by physicians who were not familiar with the reported health effects of Agent Orange. In an appendix to the report, the VA challenges these findings by citing improvements that 'have taken place since the evaluation; however, the GAO disagrees with the VA rebuttal in the same appendix. The GAO report is also critical of the registry because it cannot be used to determine the incidence of specific illnesses among veterans -- a major purpose for which the registry was supposedly designed. Medical Treatment: P.L. 97-72. Before the enactment of P.L. 97-72 in �CRS- 6 IB83043 UPDATE-03/03./83 1981, 'veterans who complained of Agent Orange-related illnesses were in a ranking of the lowest priority for medical treatment at VA hospitals. This is because these illnesses were defined as not being "service-connected." To have qualified at all for this treatment at this low-priority level, the veteran had to be destitute. The "Veterans' Health Care, Training, and Small Business Loan Act of 1981" (P.L. 97-72) elevated Vietnam veterans' priority status for treatment at VA hospitals for any Agent Orange-related problem. Veterans who complain of such problems are now considered for treatment irrespective of age or finances with the same priority status as former prisoners of war and ahead of veterans with "non-service connected" conditions. The Vietnam veterans' contention of exposure is acceptable in the absence of evidence to the contrary. It is the duty of a '"responsible staff physician (to) make a determination as to whether the condition resulted from a cause other than the specified exposure." To aid the staff physician, the VA has developed guidelines which identify conditions that are not considered to be related to Agent Orange exposure (Federal Register, Nov. 17, 1982). The VA contends that P.L. 97-72 is being implemented successfully, yet veterans' advocates and State Agent Orange commissions allege that veterans are uninformed about the new legislation and that treatment is still difficult to obtain at certain VA medical centers. The VA has initiated a new system to monitor the impact of P.L. 97-72 on Vietnam veterans' medical treatment. P.L. 97-72 also extended the readjustment counseling program for Vietnam veterans for another three years. The counseling programs are currently located in "Vet Centers," which are distinct from VA medical facilities. Disability Compensation. As of Jan. 3, 1983, veterans had filed 16,102 disability claims with the VA for disorders they attribute to Agent Orange exposure. The vast majority of these claims have been denied because they are not considered as being "service connected." The policy of the VA is that a disability is considered "service-connected" if it arises during or is aggravated by military service. "Service-connection" establishes temporal correspondence with military service, not causation, as the determinant for disability payments. Chronic conditions arising before discharge or within one year after discharge are presumed to be "service-connected." The policy implies that for a veteran to receive disability payments for ailments possibly related to Agent Orange exposure, it must be proved that the condition first appeared during the service or within a year of discharge. This precludes disability for latent disorders because "service-connection" criteria cannot be met. The VA acknowledges that the skin disorder, chloracne, is causally related to Agent Orange exposure. On Apr. 15, 1980, in a statement before the House Veterans.1 Affairs Subcommittee on Medical Facilities and Benefits, former VA administrator Max Cleland said that "the relationship between accidental human exposure to Agent Orange constituents and the development of long-term illnesses other than chloracne remains speculative at present." Even though the VA does view chloracne as an immediate effect (acute effect) of Agent Orange exposure, the basis for awarding disability stems from the occurrence of chloracne during the service. Temporal coincidence with active duty is the major criterion, irrespective of cause, for chloracne or any other veteran complaint. The total of 1237 (15.3%) claims which were granted were awarded primarily for skin conditions (94%) and for cancer, psychiatric, and neurological conditions (6%), among others. �CRS- 7 IB83043 UPDATE-03/03/83 The VA denied 6,824 claims after there was a confirmed diagnosis of the disease for which the veteran had filed a claim. The denied claims fall into the following categories: 4091 for various skin conditions; 2432 for nervousness and headache, or fatigue; 907 for paralysis or numbness; 791 for gastrointestinal or genito-urinary conditions; 487 for malignancies which include leukemia, lymphoma, melanoma, and Hodgkin's disease; 359 for impaired sexual activity; 463 for eye, ear, nose, a-nd throat pathology; 289 for lung conditions; 247 for cardiovascular conditions, and 146 claims denied for miscellaneous conditions. (Since each claim could fall into a variety of different categories, the category figures do not equal 6,824.) The VA policy is that the resolution of disability claims for conditions that are now defined as "non-service connected" (and therefore denied) will depend on the results of scientific studies which are described below. Since it is expected that these studies will take years to complete, the Chief Medical Director of the VA, Dr. Donald Custis, has testified at a hearing of the House Veterans Affairs Subcommittee on Investigations and Oversight on Sept. 15, 1982, that "It may well be that the Congress cannot wait for scientific answers in the short term, in which case it may well be that the sociopolitical aspect of this problem will have to be addressed." Current...._or. Proposed Studies of ^Health Effects Many branches of the Federal Government are conducting research on the health effects of Agent Orange and phenoxyherbicides. Research efforts range from large-scale epidemiology studies of Vietnam veterans to studies of cancer among Kansas residents exposed to herbicides. The following paragraphs provide an overview of research efforts at the Department of Defense, the Veterans Administration, and the Department of Health and Human Services. The impact of the following studies on VA disability policy is not clear; the VA has not established any formal criteria for how their policies might be altered by scientific findings. Due to the recent transfer of the legislatively mandated epidemiology study of Vietnam veterans and to the interest which this study has generated all along, it will be discussed first. E p i de m i o 1 o g y Study. The large epidemiology study of Vietnam veterans exposed to Agent Orange, mandated by P.L. 96-151 in December 1981, has been the focus of much of the debate over the health effects of Agent Orange. P.L. 96-151 directed the VA to perform the study of long-term health effects among veterans using' a protocol that was subject to approval by the congressional Office of Technology Assessment (OTA); in addition, the OTA director was given the task of monitoring the progress of the study. The protocol was reviewed by the OTA, the VA advisory group on the health-related effects of herbicides, the science panel of the Agent Orange Working Group, and the National Academy of Sciences. P.L. 97-72 allowed for future expansion of the scope of the study. The implementation of the study was delayed until October 1982, at which time the responsibility for conducting the study was transferred from the VA to the Centers for Disease Control (CDC). The transfer was accomplished following letters to the VA from the Veterans Affairs Committees of the House and the Senate. The letters expressed concern over the lack of progress on the study and concern over the VA's credibility with the veterans; consequently, the VA was urged to relinquish the. study to an independent research body. While the VA acceded to this request, former VA Administrator �CRS- 8 Nimmo'attributed the delay of the protocol review process. study IB83043 to legal UPDATE-03/03/83 challenges and to the On Jan. 18, 1983, the CDC formally accepted responsibility for the study in a written agreement with the VA. Under the agreement, the VA is to provide the CDC with $3 million to fund the study, yet the CDC is assured of autonomy in its design and implementation. The project will actually consist of two studies, one on the health effects of Agent Orange and the other on the health effects of the Vietnam experience. The study' designs are expected to be ready for OTA review in April 1983. Preliminary reports suggest that the veterans under study will be divided into three groups (cohorts) — one group made up of those who were likely to have been exposed to Agent Orange, another group constituting those who were unlikely to have been exposed, and a final group of veterans who did not serve in Vietnam and who were not likely to have been exposed. The DoD'is assisting the CDC in establishing criteria for assigning an individual veteran to a particular group. The selection process will depend on the use of DoD records ' of ground troop movements relative to herbicide spraying. Completion of the study is expected by the end of 1987. Department of Defense. The Air Force is conducting "The Ranch Hand Study," an epidemiological study of personnel exposed to herbicides during the Air Force's aerial spraying program in Vietnam (Operation Ranch Hand). These personnel were members of flight crews involved in the handling and/or spraying of herbicides, and they were presumed to have been heavily exposed. This study population of 1,260 personnel is being compared to a control population consisting of unexposed flight crew members. The purpose of the study is to determine whether Ranch Hand flight crews suffered adverse health effects compared to the control population. The study consists of three parts: a mortality study; a morbidity (disease) study which includes birth defects in offspring; and a follow-up period of physical examinations at specific intervals (up to 20 years) from the onset of the study. Information for the morbidity and follow-up portions is collected by questionnaires administered in the homes of the participants and by extensive physical and psychological tests. These data are collected by the independent contractors Louis Harris and Associates and Kelsey-Seybold Clinic, respectively. Before data collection began in 1980, the entire study protocol had been reviewed by the University of Texas School of Public Health, the U.S Air Force 'Science Advisory Board, the Armed Forces Epidemiological Board and the National Academy of Sciences. The initial phases of mortality and morbidity data collection were completed in December 1982. For the morbidity study, participation in the questionnaire and physical examination has been very high (greater than 95%) and an interim report is expected by the summer of 1983. The findings of the mortality study (due to be released early in 1983) suggest that there are no differences in the number of deaths between the Ranch Handers and controls. Periodic reassessment of the mortality findings are planned throughout the 20-year study by the Air Force School of Aerospace Medicine. While the Ranch Hand Study is expected to provide some valuable information about the population of herbicide sprayers, the applicability of the Ranch Hand Study to the experience of ground troops has been questioned. For example, the herbicide exposure conditions are thought to differ between the two groups. The Ranch Handers were heavily exposed at sporadic intervals (repeated acute exposures) and the exposure was through the skin, through inhalation, and through ingestion. After the missions, the flight crews were �CRS- 9 IB83043 UPDATE-03/03/83 required to shower. While the extent and mode of ground troop exposure are less certain, it is likely that the mode of ground troop exposure was primarily due to skin contact and to inhalation. The duration of ground troop exposure was likely to be for longer periods due to operational movements through contaminated areas. Thus, because the exposure conditions of Ranch Hand personnel did not mimic those of ground troops, the general relevance of the Ranch Hand study is not certain. One of the criticisms raised by the National Academy of Sciences in their May 1980 review of the Ranch Hand protocol was that adverse health effects were not likely to be found because the sample size was too small and the follow-up period was too short. In response, the Air Force did extend the follow-up period to 20 years; nevertheless, the problem of sample size makes it unlikely that the study will detect certain cancers that are relatively rare. The impact of Agent Orange exposure on the incidence of these rare cancers (e.g., soft-tissue sarcoma and non-Hodgkin's lymphoma), may be most appropriately determined by the case control sutdies in New York State and at.the National Cancer Institute. V e t e r ans Adm i n i s t rat ion. The Veterans Administration intends to spend $6.7 million of the total 1983 medical research budget of $163 million for projects on the health effects of herbicide exposure and, more generally, the health effects of combat duty in Vietnam. The majority of these research dollars ($4.2 million) is destined for the epidemiology study of Vietnam veterans, a mortality study, and an identical twin sibling study. Due to congressional pressure, responsibility for the conduct of the epidemiology study has been transferred from the VA to the CDC. Funding for the epidemiology study, however, will continue to be provided by the VA. Both the mortality and the twin study address the impact of the Vietnam experience rather than Agent Orange in particular. The purpose of the mortality study is to examine the cause-of-death and the death rate in Vietnam veterans by comparison to veterans who did not serve in Vietnam. The idea is to determine whether military service in Vietnam has resulted in different death profiles since the end 'of the war. Computer records will provide the information, and this information will be collected and coded by contractors for the VA. The project is expected to be finished by 1985. The Identical Twin Study, -also sponsored by the VA, is designed to determine whether the current psychological and physical health of Vietnam veterans has been adversely affected by their service. In this study, a group of VA researchers in St. Louis is attempting to study 450 pairs of identical twins; one twin served in Vietnam during the period of herbicide exposure, whereas the other twin was not stationed in Southeast Asia. Initial findings of this study are expected by October 1984. The VA has also established the Chloracne r Task Force to identify veterans with skin conditions and then to see if . there are bona fide cases of Chloracne within this group. Thus far, a dermatologist who is serving as a consultant at the Washington VA office has found 12 tentative cases of Chloracne which require further investigation. Another VA research activity is a study of dioxin in the fat tissues of veterans. In conjunction with the EPA, the VA intends to find out whether Vietnam veterans have higher levels of dioxin in their fatty tissues than non-Vietnam veterans. Background levels of dioxin in the U.S. male population are also to be analyzed. To detect dioxin concentrations in the fat, tissue is removed surgically from the abdomen and the sample .is analyzed on gas chromatography/high resolution mass spectrometry instruments. �CRS-10 IB83043 UPDATE-03/03./83 l Department of Health and_ Human Services: Centers for Disease C o n tr o1/B irth Def e_c t Stu dy. An ambitious epidemiology study is underway in Atlanta to find out if Vietnam veterans show an increased risk of having children with birth defects. Using the case-control method, CDC researchers are interviewing 7000 parents of children with birth-defects and 3000 parents whose children are normal. The interview process is used to establish the military history of the parents. This information will be analyzed to determine wheth'er parents who served in Vietnam are at greater risk of producing children with birth defects. Already one-half of the interviews has taken place, with initial findings expected by September 1983. Sponsors of the study are DHHS, VA, and DoD. DHHS: National Cancer^ I n s t i t u t e / Can c e r Study. Epidemiologists are investigating a Kansas population for the relationship between herbicide exposure and various cancers. The research question is: do such cancers as soft tissue sarcoma and various lymphomas result from herbicide exposure? Kansas residents are considered a good population for studying herbicide exposure because in this wheat-growing State herbicides are used much more often than insecticides. In other States, herbicides are frequently used in combination with insecticides, which are also implicated in producing cancer. Insecticide exposure would confound the results of such a cancer study. Preliminary results of this study are anticipated by the'fall of 1983. DHHS; National Institute of^Occupational Safety and Health/Dioxin Worker Registry. NIOSH is compiling a ' registry of workers involved in the manufacture "of 2,4,5-T and related compounds because these compounds contain dioxin as a contaminant. Worker exposure records on 3000-5000 individuals, compiled from all 12 U.S. sites of production, will go back to the 1940s. T'he purpose of the registry is to establish whether the mortality rates are higher in this,population of exposed workers than in a comparable group in the U.S.population. The protocol has been reviewed by an independent university-affiliated group of scientists, and the analysis of the findings is due by 1985. Role of State Commissions or Advisory Groups Several States have established their own agencies in response to veterans' complaints of Federal inactivity on the Agent Orange question. Although these organizations vary in structure, their functions are essentially similar: to identify State Vietnam veterans and to provide and coordinate various social services for these veterans. For example, various State commissions disseminate information on Agent Orange and assist in scheduling Agent Orange examinations at VA medical centers. Those States which have commissions or programs on Agent Orange are as follows: California, Connecticut, Georgia, Hawaii, Illinois, Kansas, Maine, Massachusetts, Minnesota, New Jersey, New York, Oklahoma, Ohio, Pennsylvania, Texas and West Virginia. (Wisconsin's program has been discontinued.) Some .of these States are funding their own research programs aimed at answering questions on the health effects of Agent Orange. In the "spring of 1983, New York is due to release findings of a study on the incidence of soft-tissue sarcoma among State veterans relative to other State inhabitants. Soft-tissue sarcoma has been implicated as a possible long-term health effect of herbicide exposure. New York State has also undertaken a mortality study to see if death rates are higher among Vietnam veterans than other State residents of the same age group. �' I CRS-11 IB83043 UPDATE-03/03/83 The New Jersey State Commission on Agent Orange has a variety of pro-jects underway. One task has been to assemble information on a bacterial infection called Melioidosis, which may have afflicted veterans who were exposed to the bacterium while in Vietnam. The Commission is beginning a project to determine whether blood tests can be reliably used to measure dioxin levels. Blood tests would obviate the need for more expensive and painful surgical procedures now performed for this purpose. In addition, the New Jersey Commission on Agent Orange distributes pamphlets on how to fill out VA disability claims forms. The role of the State commissions is growing to include advocacy for State veterans. State representatives have testified at congressional hearings and at the VA advisory committee meetings to bring attention to veterans' complaints. At the Nov. 30, 1982, meeting of the VA advisory committee on the health-related effects of herbicides, the spokesperson for State agencies endorsed legislation that would establish the presumption of a "service-connection" for chloracne and soft tissue sarcoma "so that veterans' disability claims for these disorders would be awarded. Because of the lack of State funds, some of the State commissions are no longer active and others are i.n jeopardy. State commissions have requested Federal funds on the grounds that they assist in the administration of VA programs such as the scheduling of Agent Orange examinations and informing State veterans about Agent Orange exposure. Previous Congressional Ac^tipn As previously discussed, two major pieces of legislation have been enacted in the 96th and 97th Congresses- to provide for Vietnam veterans' medical care and to mandate studies of the health effects of Agent Orange: P.L. 96-151, The Veterans' Health Programs Extension and Improvement Act of 1979; and P.L. 97-72, Veterans' Health Care, Training and Small Business Loan Act of 1981. The 'legislative proposals of the 96th and 97th Congresses were generally directed to the status of disability claims that are now denied by the VA because they are not considered as "service-connected." In Representative Daschle's proposed 97th Congress bills, H.R. 7146 and H.R. 7110, the presumption of service connection would have been legislatively established N for soft-tissue sarcoma and chloracne, respectively. The presumption of service connection would have permitted veterans with these disorders to collect disability payments because the conditions were presumed to have arisen during the service. Two other 97th Congress bills, H.R. 523 (Rep. Roe) and H.R. 2297 (Rep. Downey), were designed to provide a presumption of service connection for all chronic conditions specifically related to Agent Orange exposure which appear later than one year, after discharge. Existing law requires that disabling conditions only appearing before discharge or within one year after discharge are presumed to have arisen during the service. Finally, a number of bills were introduced to transfer the conduct of the epidemiology study from the VA to the Department of Health and Human Services. This was accomplished -- although non-legislatively -- with the transfer of responsibility to the Centers for Disease Control in the DHHS. LEGISLATION H.R. 209 (Long) Requires the Secretary of Health and Human Services to arrange for an �CRS-12 IB83043 UPDATE-03/03/83 independent epidemiological study of persons exposed to the chemical dioxin, used in the h.erbicide known as Agent Orange. Introduced Jan. 3, 1983; referred to Committee on Energy and Commerce. H.R. 212 (Long) Amends Title 38, United States Code, to waive the one-year limitation on claims for compensation "frojn the Veterans Administration for disabilities and diseases incurred in or aggravated by military service in the case of claims by veterans who served in Southeast Asia during the Vietnam era for compensation for disabilities resulting from exposure to the phenoxyherbicide known as Agent Orange or other phenoxy herbicides. Introduced Jan.3, 1983; referred to Committee on Veterans Affairs. H.R. 331 (Roe) Amends Title 38, United States Code, to waive the one-year limitation on claims for compensation from the Veterans Administration for disabilities and diseases incurred in or aggravated by military service in the case of claims by veterans who served in Southeast Asia during the Vietnam era for compensation for disabilities resulting from exposure to the phenoxy herbicide known as "Agent Orange" or other phenoxy herbicides. Introduced Jan. 3, 1983; referred to Committee of Veterans Affairs. H.R. 462 (Applegate) Amends Title 38, United States Code, to waive the one-year limitation on claims for compensation from the Veterans Administration for disabilities and diseases incurred in or aggravated by military service in the case of claims by veterans who served in Southeast Asia during the Vietnam era for compensation for disabilities resulting from exposure to the phenoxyherbicide known as Agent Orange, or other phenoxy herbicides. Introduced Jan. 6, 1983; referred to Committee on Veterans Affairs. H.R. 509 (Hammerschmidt) Amends Title 38 of the United States Code to provide that progressive muscular atrophy or amyotrophic lateral sclerosis developing a 10 per centum or more degree of disability within seven years after separation from active service during a period of war shall be presumed to be service connected. Introduced Jan. 6, 1983; referred to Committee on Veterans' Affairs. H.R. 1135 (Downey) Amends Title 38, United States Code, to waive the one-year limitation on claims for compensation from the Veterans Administration for disabilities and diseases incurred in or aggravated by military service in the case of claims by veterans who served in Southeast Asia during the Vietnam era for compensation for disabilities resulting from exposure to the phenoxy herbicide known as Agent Orange, or other phenoxy herbicides. Introduced Feb. 1, 1983; referred to Committee on Veterans Affairs. H.R. 1382 (Downey) Provides that any award by the Veterans' Administration of compensation for a disease or disability in a veteran resulting from exposure to Agent Orange shall be retroactive to the date the veteran first applied to the Veterans' Administration for compensation for such disease or disability. I n t r o d u c e d _ F e b . 10, 1983; referred to Committee on Veterans' Affairs. �CRS-13 IB83043 UPDATE-03/03/83 '*. i S. 374 (Specter) A m e n d s Title 38, United States Code, to provide a presumption of service connection for the occurrence of certain diseases in veterans who were exposed to phenoxy herbicides while serving in the Armed Services in Southeast Asia during the Vietnam era. Introduced Feb. 2, 1983; referred to Committee on Veterans Affairs. HEARINGS U.S. Congress. House. Committee on Interstate and Foreign Commerce. Subcommittee on Oversight and Investigations. Agent Orange: exposure of Vietnam veterans. Hearing, 96th Congress, 2d session. Sept. 25, 1980. 249 p. Involuntary exposure to Agent Orange and other toxic spraying. Hearings, 96th Congress, 1st session. June 26 and 27, 1979. 256 p. U.S. Congress. House. Committee on veterans' Affairs. Ad Hoc Subcommittee on Hospitals and Health Care. Legislation to improve medical programs administered by the Veterans Administration (H.R. 2157, H.R. 2953, and H.R. 2999). Hearing, 97th Congress, 1st session. Apr. 28, 1981. 54 p. U.S. Congress. House. Committee on Veterans' Affairs. Subcommittee on Medical Facilities and Benefits. Herbicide "Agent Orange." Hearing, 95th Congress, 2d session. Oct. 11, 1978. 62 p. Oversight hearing to receive testimony on Agent Orange. Hearing, 96th Congress, 2d session. Feb. 25, 1980. 121 p. ._ _, oversight hearing to receive testimony on Agent Orange. Hearing, 96th Congress, 2d session. July 22, 1980. 459 p. Scientific community report on Agent Orange. Hearing, 96th Congress, 2d session. Sept. 16, 1980. 145 p. U.S. Congress. House. Committee on Veterans' Affairs. Subcommittee on Oversight and Investigations. Current status of Agent Orange studies. Hearing, 97th Congress, 1st session. May 6, 1981. 385 p. Federal Agent Orange activities and the vet center program. Hearing, 97th Congress, 2d session. Sept. 15, 1982. 164 p. U.S. Congress. Senate. Committee on Veterans' Affairs. Agent Orange update and appendix: Agent Orange activities (part II) . Hearing, 96th Congress, 2d session. Sept. 10, 1980. 1368 p. Oversight on issues related to Agent Orange and other herbicides. Hearing, 97th Congress, 1st session. Nov. 18, 1981. 500 p. �CRS-14 IB83043 UPDATE-03/03,/83 VA health resources and program extensions and appendix: Agent Orange activities. Hearing, 96th Congress, 1st session, on S. 741 and S. 196. Apr. 10, 1979. 462 p. Veterans' Programs Extension and Improvement Act of 1981. Hearing, 97th 'Congress, 1st session, on S. 26 (titles II and III, only), S. 380, S. 458, S. 636, S. 689, S. 872, S. 914, S. 921, and related bills. Apr. 30, 1981. 685 p. Vietnam veterans' readjustment. Hearings, 96th Congress, 2d session. - F e b . 21, Mar. 4, and May 21, 1980. Part 2. 595-2082 p. i ADDITIONAL REFERENCE SOURCES American Medical Association. Council on Scientific Affairs. Health effects of "Agent Orange" and dioxin contaminants. 1981. 37 p. Boffey, Philip. Agent Orange: Despite spate of studies, slim hope for answers. New York Times, 1982. 24 p. Cookson, Clive. "Emergency" ban on 2,4,5-T herbicide in U.S. Nature, v. 278, Mar. 8, 1979: 108-110. Galston, Arthur W. Herbicides: V. 29, Feb. 1979: 85-90. a mixed blessing. Bioscience, International Agency for Research on Cancer. IARC monographs on the evaluation of the carcinogenic risk of chemicals to man: 2,5,5-T, v. 15, Aug. 1977. JRB Associates. Review of literature on herbicides, including phenoxy herbicides and associated dioxins. Washington, Veterans Administration, 1981. 2v. National Research Council. The effects 1 of herbivcides in South Vietnam: Part A. Summary and conclusions. Washington, National Academy of Sciences, 1974. AD-774-749. 398 p. National Research Council. The effects of exposure to Agent Orange on ground troops in.Vietnam. Washington, National Academy of Sciences, 1982. 24 p. New Jersey State Commission on Agent Orange. 1982. 54 p. Legislative Report. Reggiani, G. Toxicology of TCDD: short review of its formation, occurrence, toxicology and kinetics, discussing human health effects, safety measures and disposal. Regulatory Toxicology and Pharmacology, v. 1, 1981: 211-243. Rosenblatt, Jean. Compensating victims of toxic substances. Editorial Research Reports. v. 11, Oct. 1982: 759-772. Tung, T.T., T.K. Anh, B.Q. Tuyen, D.X. Tra, and N.X. Hugen (1971). Clinical effects of massive and continuous utilization of �'V* 1 CRS-15 -* ». U.S. IB83043 . defoliants on civilians. . . . Vietnamese Studies, 29: . UPDATE-03/03/83 . 53-81. General Accounting Office. U.S. ground troops in South Vietnam were in areas sprayed with herbicide orange. Nov. 16, 1979. FPCD-80-23. VA's Agent Orange examination program: auctions needed to more effectively address veterans' health concerns. Oct. 25, 1981. HRD-83-6. Young, Alvin et al. The toxicology, environmental fate and human risk of herbicide orange and its associated dioxin. The Surgeon General, U.S. Air Force, Washington, D.C. Oct. 1978. �APPENDIX A LISTING OF FEDERAL ORGANIZATIONS ON AGENT ORANGE January, 1983 I. Cabinet Council on Human Resources Agent Orange Working Group (AOWG) Chairman: James Stockdale (HHS) Alternate: Bart Kull Members: HHS, VA, DoD, Dept. Agriculture, Dept. Labor, EPA, ACTION Agency, OMB, OSTP, Council of Economic Advisors, Dept. State (OTA- Observer Status) Activities: Moniter and coordinate Federal Research activities on health effects of Agent Orange. Science Panel: Dr. Vernon Houk (CDC) II. Veterans Administration Advisory Committee on Health Related Effects of Herbicides Chairman: Dr. Barclay Shephard (VA) Members: VA, Veterans Groups, FDA, CDC, EPA, Army Medical Corps, Dept. Agriculture, NIH, private universiites Activities: Advise Administrator of VA on health effects of Agent Orange Agent Orange Projects Office Acting Director: Dr. Barclay Shephard (VA) Members: In-house administrative and research staff, Dept. of Medicine and Surgery, VA Activities: Coordinate and moniter epidemiology projects at VA on Agent Orange and related research effortsAgent Orange Policy Coordinating Committee Chairman: Everett Alvarez, Jr. (VA) Members: In-house staff involved in medical information and medical claims. Activities: Review VA policy to make recommendations on Agent Orange issues to the administrator of the VA. III. Department of Defense Army Agent Orange Task Force (AAOTF) Chief: Richard Christian (Army) Members: Army, Navy, Air Force, Marines, and civilian staff Activities: Provide VA with information from military records for the research projects on Agent Orange. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 032 Folder The folder containing the original item. 0589 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Davis, Miriam Michael Simpson Description An account of the resource <strong>Corporate Author: </strong>The Library of Congress Congressional Research Service, Major Issues System Date A point or period of time associated with an event in the lifecycle of the resource March 3 1983 Title A name given to the resource Agent Orange: Veterans' Complaints and Studies of Health Effects, Issue Brief Number IB83043 Subject The topic of the resource VA health studies legislation ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 032 Folder The folder containing the original item. 0592 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource DeHart, Roy Source A related resource from which the described resource is derived Aviation, Space, and Environmental Medicine Date A point or period of time associated with an event in the lifecycle of the resource 1982-05-01 Title A name given to the resource Guest Editorial: Herbicide Orange Health Effects Subject The topic of the resource Ranch Hand health studies ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 033 Folder The folder containing the original item. 0645 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Ferry, D. G. L. R. Gazeley I. R. Edwards Source A related resource from which the described resource is derived Proceedings of the University of Otago Medical School Date A point or period of time associated with an event in the lifecycle of the resource 1982 Title A name given to the resource 2,4,5 - T Absorption in Chemical Applicators Subject The topic of the resource dioxin herbicide properties health studies ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 034 Folder The folder containing the original item. 0691 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Gunby, Phil Source A related resource from which the described resource is derived Journal of the American Medical Association Date A point or period of time associated with an event in the lifecycle of the resource August 17 1979 Title A name given to the resource Plenty of Fuel for Agent Orange Dispute Subject The topic of the resource dioxin health studies ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 034 Folder The folder containing the original item. 0692 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Gunby, Phil Source A related resource from which the described resource is derived Journal of the American Medical Association Date A point or period of time associated with an event in the lifecycle of the resource April 6 1979 Title A name given to the resource Dispute Over Some Herbicides Rages in Wake of Agent Orange Subject The topic of the resource EPA litigation health studies ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 034 Folder The folder containing the original item. 0693 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Gunby, Phil Source A related resource from which the described resource is derived Journal of the American Medical Association Date A point or period of time associated with an event in the lifecycle of the resource May 27 1983 Title A name given to the resource More Questions, Not Answers, Emerge From Agent Orange Studies Subject The topic of the resource health studies VA CDC Australia ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 036 Folder The folder containing the original item. 0768 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Hryhorczuk, Daniel O. William A. Withrow Carolyn S. Hesse Val R. Beasley Source A related resource from which the described resource is derived Archives of Environmental Health Date A point or period of time associated with an event in the lifecycle of the resource Sept./October 1981 Title A name given to the resource A Wire Reclamation Incinerator as a Source of Environmental Contamination with Tetrachlorodibenzo - p - dioxins and Tetrachlorodibenzofurans Subject The topic of the resource industrial exposure EPA health studies ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 036 Folder The folder containing the original item. 0769 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Hudson, A. J. Source A related resource from which the described resource is derived Archives of Neurology Date A point or period of time associated with an event in the lifecycle of the resource 1977-11-01 Title A name given to the resource Amyotrophic Lateral Sclerosis and Toxic Hydrocarbons Subject The topic of the resource health studies ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 036 Folder The folder containing the original item. 0770 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Ideo, G. Title A name given to the resource Final Report on the Results of D-Glucaric Acid Determinations Done at Seveso in Adults and Children in the period 1978-1982 Subject The topic of the resource Italy health studies TCDD ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 036 Folder The folder containing the original item. 0775 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Description An account of the resource <strong>Corporate Author: </strong>International Steering Committee for the Study of the Health Effects of the Seveso Accident Date A point or period of time associated with an event in the lifecycle of the resource 1982 Title A name given to the resource Recommendations Issued by the International Steering Committee at its 5th Meeting Held in Milano, January 9-12, 1982. Subject The topic of the resource Italy industrial exposure TCDD health studies ao_seriesIII Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">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.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 036 Folder The folder containing the original item. 0780 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Janerich, Dwight T. William S. Burnett Gerald Feck Margaret Hoff Philip Nasca Anthony P. Polednak Peter Greenwald Nicholas Vianna Source A related resource from which the described resource is derived Science Date A point or period of time associated with an event in the lifecycle of the resource June 19 1981 Title A name given to the resource Cancer Incidence in the Love Canal Area Subject The topic of the resource toxic wastes health effects health studies New York ao_seriesIII