Monday, August 30, 2010

Agent Orange: time to pay up

The headline on POLITICO this morning features a lengthy article covering the long awaited bill the government will have to pay to Vietnam veterans exposed to Agent Orange.

"It’s a world turned upside-down from decades ago when returning soldiers had to fight to get attention for deadly lymphomas linked to the herbicide. Now the frailties of men in their 60s — prostate cancer, diabetes, heart disease — lead the list of qualified Agent Orange disabilities, and the result has been an explosion in claims — and the government’s liability.

The latest expansion, approved by Veterans Affairs Secretary Eric Shinseki in October, adds ischemic heart disease and Parkinson’s and will cost at least $42 billion over the next 10 years. The VA estimates 349,000 individuals are already receiving Agent Orange disability benefits and that number could soon reach 500,000 — or one out of every four surviving Vietnam veterans by the VA’s count."

Agent Orange is something we all learn about one point or another in toxicology research. Not only because a large number of people were exposed and but also because we can still observe the toxic legacy of Agent Orange today - whether it be development of cancers in exposed veterans or the nearly 500,000 Vietnamese born with birth defects. Since I work on environmental contaminants (which include a large variety of herbicides), we also focus on the manufacturing process. Because anytime you combust hydrocarbons at high temperatures in the presence of halogens (like chlorine) you are likely going to form some really nasty dioxins.

In the case of Agent Orange, a chlorinated herbicide, the manufacturing process lead to the contamination of one form of Agent Orange with 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD). TCDD is especially important in our field because it is such a potent inducer of the aryl hydrocarbon receptor (AhR), which triggers a cascade of reactions to metabolize and detoxify foreign chemicals. In fact, the toxicity of other organic contaminants are measured as ratio of their AhR induction compared to that of TCDD. In other words, the toxicity of TCDD is the measuring stick in which we compare the toxicity of other relevant chemicals to. This ratio is known as the toxic equivalent factor and can be a useful tool in environmental risk assessment.

But bringing this back to the veterans, there is still hesitation from both politicians and scientists to support the newly added diseases to the veteran compensations.
"The VA had contributed an important piece with a 2006 study analyzing the incidence of heart disease among Vietnam veterans who had served in the Army Chemical Corps. And Shinseki, who himself served in Vietnam, found that this built on well-established evidence that dioxins present in Agent Orange could damage blood vessels. “Veterans who endure health problems deserve timely decisions based on solid evidence,” he said.

Nonetheless, the leader of the IOM panel, Dr. Richard Fenske of the University of Washington, told POLITICO that he was “surprised by the speed” with which the VA decided to add the presumption for heart disease. And Weidman argued that the department repeatedly ignores what he sees as a central tenet of the 1991 law: that more should be invested in scientific studies of veterans themselves.

“The whole concept of the 1991 law was to leave it to science, not politics, but we haven’t invested in the science in the 20 years since,” he said. In a shot back at Webb, he added: “If you want more scientific data, fund the damn science.”

For all the debate over Agent Orange, what’s most surprising is how little or no effort has been made to track down specific infantry units that operated in the widely sprayed areas of Vietnam."

Kind of sad really. Though one thing the article ends with that I can agree with; this kind of retroactive tracing of exposure is slow and inaccurate and just further emphasizes the need for electronic medical records. Not only useful for civilians but for military personnel is could easily be used to track from the time of enlistment to retirement which individuals were exposed to what chemicals, the exposure level, and what health effects develop later in life.

As best said by German thrasher Tom Angelripper, "Agent Orange - the fire that doesn't burn!"

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