Environmental Exposures of Gulf War and Vietnam Veterans

September 18, 2003
1:28 pm US Eastern Time

Call Notes


Facilitator: Steve Heilig, M.P.H., Co-Director of CHE, Director of Public Health & Education, San Francisco Medical Society

1. Science Update on Dioxin 2003: Steve Lester, Science Director, Center for Health, Environment and Justice (CHEJ)

There were more than 70 papers on brominated flame retardants, but there is still little known about the toxicity of these compounds. There were also a number of papers on the continuing follow-up of the people exposed in Seveso, Italy and the Uchang in Taiwan. The Seveso reports showed increases in the risk ratios of both Endometriosis and Breast Cancer, but the increases were not statistically significant. They also looked at the impact on the development of teeth of Seveso children and found that 33% had developmental defects, compared to 17% in controls.

There were also a number of papers on the Ranch Hand studies. Two papers showed an increase in prostate cancer and malignant melanoma. Earlier studies compared Veterans who were involved in spraying Agent Orange and those who weren't. This time they looked at the amount of time the soldiers spent in Vietnam.

There was a presentation by the FDA on levels of dioxin in food. They said it would cost $4-6 billion to remove dioxin-contaminated food from the U.S. food supply and that this was too much to spend.

Also presented were recent findings of a new set of ubiquitous perflorinated compounds, which are found in food packaging.

Anther paper presented a reanalysis of half the life of dioxins in blood and challenged the notion that typical half-life in blood was 7 years.


2. CHE Feature: Environmental Exposures of Gulf War and Vietnam Veterans

First Speaker: Vietnam War - Paul Sutton, National Chairperson, VVA National Agent Orange/Dioxin Committee

We have a delegation leaving for Vietnam tomorrow to meet with some of the Vietnamese scientific community members who are the driving force inside Vietnam. We've been working with the Vietnamese government and the American Friends Service Committee, to identify "hot spots" where we operated during the war. We have been soliciting documentary evidence from soldiers who served there, at bases where herbicides (agents white, orange, blue, and purple,) were shipped and loaded, then sprayed around Vietnam.

We have been learning that if we take the sum of chemical we know to have been sprayed, which totals 23 million gallons, 50% of that figure (11million gal) we know to have been purposely discarded, dumped or buried inside Vietnam. We're trying to determine how to remediate the various sites we can identify, including the 38 acre site at Danang Airport, for example, where unused chemicals were buried.

We are currently working to identify other sites and convey this dump site information back to the Vietnamese so they can determine where they want to remediate first. We have agreements to help clean up some of these sites, but do to some hang-ups, nothing has been done in the last 6-8 months.


Second Speaker: Vietnam War - Dr. Linda Schwartz, Principal investigator, Vietnam Nurse Health Study, Yale University School of Nursing

We're doing the Vietnamese Nurses Health Study, but we're not in process of doing blood levels yet, because we're focusing on interviews. We've been working with Dr. George Clark and with the Scientific Advisory Committee of the Vietnam Veterans Longitudinal Study, looking at dioxin levels to see if there are any that are discernable and that might lend themselves to any extrapolation further down the road. We've been looking at the serum-dioxin levels in the ranch-hand data.

Third Speaker: Vietnam War - Dr. George Knafl, Co-author with Dr. Schwartz on a paper looking at birth defects in the children of Vietnam Veterans' who sprayed Agent Orange

We're not making any assumptions about models of how to extrapolate samples back in time. We're using observed values, but we're adaptively choosing the dose-response relationship, to work with the data that we have rather than with some model that we couldn't justify.


Fourth Speaker: Gulf War - Robert W. Haley, M.D., Director, Division of Epidemiology and Preventive Medicine at University of Texas Southwestern Medical Center

This field is 20 years younger, but promising developments are presenting themselves. We sent 700,000 troops to Gulf War 1. They came home with a high rate of a dramatic illness. People were lined up, with fevers, body pains, flu-like illness, and cognitive problems. Rheumatology Fellows and Infectious Disease Fellows at Walter Reed were unable to find an infectious cause.

Over the years, research has presented the following factors:
 (1) Widespread sarin nerve gas exposure. Early in the war, the bombing of chemical factories and stores liberated large amounts of sarin. After the ground war was over, we demolished ammunition dumps that released it further. The General Accounting Office's latest study indicates that every service person was exposed to low-level sarin.
 (2) Large amounts of bromide tablets were given to thousands for chemical exposure. Many people suffered severe side effects.
 (3) There's a lot of concern about an infectious intercellular organism that can remain in chronic infection. In the early AIDS era, this was thought to be a co-factor in the mortality rate. That was later disproven. There are now 2 major studies that suggest that this is not related.
 (4) Inhalation of the dust of spent uranium shells has also been a concern. Animal studies have shown increased rates of cognizant problems, tumors, birth defects and cancer.

Summary of Evidence:
A new finding on general neurology will be released on Monday, which includes 2 papers (one is Dr. Haley's paper, the other is from a set of VA investigators). These papers present an increased rate of ALS disease in GW Veterans (ages 20-40 years). Dr. Haley found that 2/3 of vets with ALS came home with Gulf War Syndrome. ALS may be a late sequella of GWS in people who have the susceptibility for getting ALS. GWS has a lot in common with some of the neuro-cognitive problems (difficulty thinking and concentrating, body pains, balance disturbances, chronic diarrhea, etc.) that we saw in Vietnam Veterans. It appears to be a brain cell injury to deep brain structures. More studies are being done on this. Evidence for immunizations is still all immunologic and is still under research.

Three groups are doing animal studies and have found that they can produce subtle neurological symptoms in animals with some of these dioxins, particularly in combination. Another replicated the sarin exposures in rats, and found that 5 days of exposures produced immediate effects, but 30 days out they developed receptor loss in basal ganglia in the anterior lobe of the lung in the rat. We now have an animal model of GWS from nerve gas.

We have seen that initial studies showed no excessive levels of birth defects, but two new studies show significantly elevated risks in both birth defect and miscarriage rates in GW Veterans. We looked at the before and after birth rates of the same families in 6 state birth defect registries. We've seen an increase in problems with Parkinson's Disease, and there has been talk of an increase in brain tumors and MS. There is no evidence on brain tumors or MS yet.

3. Discussion followed, with the following policy addendum

Rich Liroff, World Wildlife Fund:

On Friday, September 5, Senator Mary Landrieu of Louisiana introduced into the Senate S.1588, the Environmental Health Research Act of 2003. This is the companion bill to HR852 introduced earlier this year by Representative Louise Slaughter. It is the first major legislation on hormone disrupting chemicals since enactment of the Food Quality Protection Act in 1996. It provides for the National Institute of Environmental Health Sciences to direct a coordinated federal research program on hormone disrupting chemicals and to report to the public every two years on exposures and effects. WWF is asking grassroots activists to contact their Senators and Representatives to request their co-sponsorship of S1588/HR852. I ask that for those of you who are able to invite your activists to contact their senators and representatives. For more information contact Rich at rich.liroff@wwfus.org or visit http://www.takeaction.worldwildlife.org/action.asp?step=2&item=2773


4. Announcements and Next Call

Our next Partnership Call, is scheduled for Thursday, October 23 at 10 a.m. PDT, 1 p.m. EDT. This call will be on REACH and European Chemical Policy.

CHE is co-sponsoring a conference "Medicine and the Environment:
A Clinical, Scientific and Public Health Update" on Saturday, November 15, 2003, at the University of California, San Francisco. This meeting is timed to coincide with the annual national meeting of the American Public Health Association, which begins in San Francisco the same day. We invite CHE Partners and colleagues to join us for this one-day conference.