The association between herbicides and diabetes is "limited and suggestive" and far from certain, said a panel of experts convened by the National Academy of Sciences' Institute of Medicine. Nevertheless, it's strong enough that it may pave the way for diabetes to join the short list of diseases for which Vietnam veterans can get more or less automatic compensation.
The number of veterans who might be affected by such a ruling is huge. About 2.6 million people served in Southeast Asia between 1962 and 1975. Depending on what estimate is used, 8 percent to 11 percent of them now have diabetes. Because risk of developing the disease increases with age, the percentage will rise in the future.
Three of the eight diseases (or categories of diseases) officially considered to be associated with herbicide exposure got that designation on the basis of "limited/suggestive" scientific evidence, which is the strength of the evidence that exists with diabetes. For the other five diseases, there is a stronger link between exposure and illness.
Agent Orange--and its possible effects on veterans--has been one of the Vietnam War's longest legacies. The defoliant, which contains the toxic compound dioxin, was sprayed on trees to reduce cover for Viet Cong and North Vietnamese soldiers. The number of American soldiers in direct contact with the compound was small. (About 1,300 people participated in Operation Ranch Hand, the Air Force program that did most of the aerial spraying.) Nevertheless, many veterans attribute illnesses they developed years after military service to the herbicide.
In 1991, Congress passed the Agent Orange Act, which established a system for evaluating health effects of the herbicide and disease. The National Academy of Sciences reviews scientific studies at least every other year and rates any association between herbicides and diseases.
If the secretary of veterans affairs finds the "credible evidence" for a link between a disease and herbicide exposure "is equal to or outweighs" evidence against a link, then he must rule that veterans with the disease can be compensated. Former soldiers don't have to show they had contact with herbicides. If they were in Vietnam during the designated 13-year period, it is assumed they were exposed. About 8,500 veterans have collected benefits under the Agent Orange law.
The standards for saying there is "limited/suggestive" evidence for an association between herbicide and disease are far from proof of causation.
Each review puts the cumulative scientific evidence into one of four categories. The lowest is "limited/suggestive" evidence against an association. The second is "inadequate/insufficient" evidence for or against. The third is "limited/suggestive" evidence for, and the top is "sufficient" evidence for.
Diabetes moved up from the "inadequate/insufficient" category in the new report. A study of Operation Ranch Hand veterans and other Air Force veterans showed no increase in diabetes in the former group. However, the higher the bloodstream concentration of dioxin (as measured in the 1980s) in the Ranch Hand veterans, the greater their risk of developing diabetes. One study of residents near a dioxin-contaminated site in Arkansas found similar "dose-response" abnormalities in the body's insulin response to sugar.
Several studies showed no significant increase in deaths from diabetes among 13,000 Europeans with exposure to dioxin between 1939 and 1992. However, because people with diabetes often die of other diseases (such as heart disease or kidney failure) that diabetes contributes to, the lack of association doesn't rule out a connection between the dioxin and the disease.
Other diseases designated as herbicide associated are: chloracne (a skin condition); porphyria cutanea tarda (a metabolic disorder); soft tissue sarcomas; Hodgkins disease; multiple myeloma; respiratory cancers (including lung cancer); prostate cancer; and non-Hodgkins lymphoma. Spina bifida in the children of veterans also is considered to be associated with Agent Orange exposure, and can be grounds for compensation.
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