[Congressional Record Volume 142, Number 35 (Thursday, March 14, 1996)]
[Senate]
[Pages S2098-S2099]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
NATIONAL ACADEMY OF SCIENCES FOLLOW-UP REPORT ON AGENT ORANGE
Mr. DASCHLE. Mr. President, I would like to call to our colleagues'
attention important new findings on the relationship between Agent
Orange exposure and certain health conditions. Earlier today, the
Institute of Medicine [IOM], which is part of the National Academy of
Sciences [NAS], released an update to their 1994 report, ``Veterans and
Agent Orange: Health Effects of Herbicides Used in Vietnam.'' These
reports were mandated in the Agent Orange Act of 1991 (Public Law 102-
4), which I authored with Senator John Kerry, Senator Alan Cranston and
Representative Lane Evans.
This report confirms what Vietnam veterans have long known: The
Vietnam war is still claiming innocent victims.
Unfortunately, the findings announced today validate veterans' worst
fears about Agent Orange--that their children are suffering serious
health consequences as a result of their parents' military service.
The report found evidence suggestive of an association between
veterans' exposure to Agent Orange and the presence of a severe form of
spina bifida in their children.
This type of spina bifida is an incurable birth defect characterized
by a deformity in the spinal cord that often results in serious
neurological problems, which require lifelong medical
[[Page S2099]]
treatment. The cost of caring for a child with spina bifida can
devastate a family.
The report concluded that there is inadequate evidence at this time
to determine whether there may be an association to Agent Orange
exposure and any other birth defects.
The Federal Government has a moral responsibility to help veterans
whose children suffer from spina bifida and to meet their children's
health care needs. This should include the provision of essential
medical care and case management services to coordinate health and
social services for the child.
But the Government's responsibility does not end there. American
soldiers were exposed to Agent Orange, and some of their children are
now paying a terrible price. The Federal Government also has a
responsibility to compensate these families.
Department of Veterans Affairs Secretary Jesse Brown has said he will
appoint a task force to review the findings of the new IOM-NAS report
and make policy recommendations to him within 90 days. I applaud the
Secretary for his aggressive pursuit of the scientific facts related to
Agent Orange and am hopeful that the task force will help Congress and
the Secretary identify appropriate measures to address this
unprecedented situation.
Toward that end, I am asking Secretary Brown to direct the task force
to consider the following several specific questions as part of their
review:
First, what is the most appropriate way to provide health care to
veterans' children with spina bifida--through the VA directly or
through contracts with other providers?
Second, what kinds of case management services are needed to maximize
the quality of life for these children, and their ability to function?
And how can they be delivered most effectively?
Third, should veterans' children with other birth defects be provided
those same services?
Finally, what is the most appropriate means of compensating the
families of children who suffer from spina bifida as a result of their
parent's exposure to Agent Orange?
I am also asking the Secretary to ensure that the task force, as it
considers these questions, seeks the input of organizations and
individuals familiar with the unique treatment and case management
needs of children suffering from spina bifida and other birth defects.
I also hope the panel will consult with experts in the field of injury
compensation for children. Congress and the VA have an obligation to
seek and heed the best advice these experts have to offer.
We need answers to these questions as soon as possible. The families
of these children need help, and they have waited long enough.
Mr. President, the association between Agent Orange exposure and
spina bifida was not the only new finding in this report. The IOM
Committee also updated its finding on skin cancer, moving it from
category IV--``uggestive of no association with exposure''--to category
III--diseases for which there is ``insufficient evidence to make a
determination.''
This change underscores the fact that we still do not understand
fully the long-term effects of Agent Orange exposure. To facilitate my
colleagues' and the public's understanding of these findings, I ask
that a table from today's report, which explains the four-tiered
classification system and summarizes the results of this study, be
printed at the close of my remarks.
The PRESIDING OFFICER. Without objection, it is so ordered.
(See exhibit 1.)
Mr. DASCHLE. Until we have all the facts, Congress must continue, as
we have done since 1981, to give veterans the benefit of the doubt and
provide them free health care for conditions potentially related to
their exposure.
The NAS is helping us compile an important scientific record that is
instrumental to Congress' effort to address the health and compensation
needs of veterans. I commend the Institute of Medicine for its
excellent work. This report builds on our scientific knowledge of the
long-term health consequences of exposure to Agent Orange and other
herbicides. It recognizes that our understanding of these issues is
still evolving. And it recommends additional work that should be done
to further that understanding.
The NAS report also serves as a valuable reminder that the impact of
war is felt decades beyond the final shots. This holds for the Persian
Gulf war as well as the war in Vietnam. We must be prepared to learn
from the scientific effort on Agent Orange and apply these lessons to
the effort to discover the true health effects of environmental hazards
on the men and women who served in the gulf and on their children.
I look forward to working with the Senate Veterans' Affairs
Committee, veterans organizations, the Department of Veterans Affairs,
the NAS, independent scientists, and others to address the issues
raised in this report and to continue to search for the truth and a
better understanding of the lasting health effects of military service.
Exhibit 1
Table 1-1. Updated summary of findings in occupational,
environmental, and veterans studies regarding the association
between specific health problems and exposure to herbicides.
sufficient evidence of an association
Evidence is sufficient to conclude that there is a positive
association. That is, a positive association has been
observed between herbicides and the outcome in studies in
which chance, bias, and confounding could be ruled out with
reasonable confidence. For example, if several small studies
that are free from bias and confounding show an association
that is consistent in magnitude and direction, there may be
sufficient evidence for an association. There is sufficient
evidence of an association between exposure to herbicides and
the following health outcomes: Soft-tissue sarcoma, non-
Hodgkin's lymphoma, Hodgkin's disease chloracne.
limited/suggestive evidence of an association
Evidence is suggestive of an association between herbicides
and the outcome but is limited because chance, bias, and
confounding could not be ruled out with confidence. For
example, at least one high-quality study shows a positive
association, but the results of other studies are
inconsistent. There is limited/suggestive evidence of an
association between exposure to herbicides and the following
health outcomes: Respiratory cancers (lung, larynx, trachea),
prostate cancer, multiple myeloma, acute and subacute
peripheral neuropathy (new disease category), spina bifida
(new disease category), porphyria cutanea tarda (category
change in 1996).
inadequate/insufficient evidence to determine whether an association
exists
The available studies are of insufficient quality,
consistency, or statistical power to permit a conclusion
regarding the presence or absence of an association. For
example, studies fail to control for confounding, have
inadequate exposure assessment, or fail to address latency.
There is inadequate or insufficient evidence to determine
whether an association exists between exposure to herbicides
and the following health outcomes: Hepatobiliary cancers,
nasal/nasopharyngeal cancer, bone cancer, female reproductive
cancers (cervical, uterine, ovarian), breast cancer, renal
cancer, testicular cancer, leukemia, spontaneous
abortion, birth defects (other than spina bifida),
neonatal/infant death and stillbirths, low birthweight,
childhood cancer in offspring, abnormal sperm parameters
and infertility, cognitive and neuropsychiatric disorders,
motor/coordination dysfunction, chronic peripheral nervous
system disorders, metabolic and digestive disorders
(diabetes, changes in liver enzymes, lipid abnormalities,
ulcers), immune system disorders (immune suppression and
autoimmunity), circulatory disorders, respiratory
disorders, skin cancer (category change in 1996).
Limited/Suggestive Evidence of No Association
Several adequate studies, covering the full range of levels
of exposure that human beings are known to encounter, are
mutually consistent in not showing a positive association
between exposure to herbicides and the outcome at any level
of exposure. A conclusion of ``no association'' is inevitably
limited to the conditions, level of exposure, and length of
observation covered by the available studies. In addition,
the possibility of a very small elevation in risk at the
levels of exposure studied can never be excluded. There is
limited/suggestive evidence of no association between
exposure to herbicides and the following health outcomes:
Gastrointestinal tumors (stomach cancer, pancreatic cancer,
colon cancer, rectal cancer), bladder cancer, brain tumors.
Note.--``Herbicides'' refers to the major herbicides used
in Vietnam: 2,4-D (2,4-dichlorophenoxyacetic acid); 2,4,5-T
(2,4,5-trichlorophenoxyacetic acid) and its contaminant TCDD
(2,3,7,8-tetrachlorodibenzo-p-dioxin); cacodylic acid; and
picloram. The evidence regarding association is drawn from
occupational and other studies in which subjects were exposed
to a variety of herbicides and herbicide components.
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