[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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