Description: The Institute of Medicine (IOM) appointed a committee to review health effects in Vietnam veterans exposed to herbicides. Their charge specifically examines the length of the presumptive period for association between exposure and respiratory cancer. This small volume follows the 1994 book, Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam, and its biennial updates published through 2002.
Purpose: Specifically, this book examines the length of the presumptive period for association between exposure and respiratory cancers. The committee's charge was limited in the sense of "limited/suggestive" evidence of an association between at least one chemical, that being 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and development of respiratory cancers.
Audience: This 56-page treatise will likely be referenced by claims examiners, legal staffs, and others involved in the administrative process relative to Vietnam veterans.
Features: This book is organized into four primary chapters, the introduction, evaluation of latent and presumptive periods, epidemiologic studies and conclusions. There is also an executive summary section. The book includes a hypothetical construct describing the time courses for exposure and manifestation of disease as well as a model showing how time-related factors are connected.
Assessment: The authors have been somewhat selective in limiting toxicology to merely "toxicokinetic and mechanistic data related to TCDD." While they may have performed calculations to describe critical serum or fat concentrations of TCDD, sample calculations or findings are not included. I was also disappointed that they did not choose to discuss any toxicodynamic data. Their exclusion of discussion of cell-mediated immunosuppressive properties for TCDD (estimated as long as 20 years) is similarly puzzling to me. However, in fairness, the book is probably adequate given the limitations imposed upon the committee's work.