l[EVELU'0 %W, INI AIR COMMAND AND STAFF COLLEGE STUDENT RESEARCH REPORT AGENT ORANGE AT THE CROSSROADS OF a.. SCIENCE AND SOCIAL CONCERN 0 2750-81 1 4isgt 11111 into tomorrow'4 +D(ISTRrBunON STA b' • •'- . ... ...... ...... ** ....... . .. ..... . .. - . ... -' .... .. fo - - .;Ab.L•"4.. . .. . '. The views and opinions expressed in this document represent the personal views of the author only, and should not in any way be construed to reflect any endorsement or confirmation by the Department of Defense, the Department of the Air Force, or any other agency of the United States Government. 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Copies of technical and logistics related studies are provided to the Defense Technical Information Center (DTIC) as a convenience to subscribers.- Sudjet to expnott controh laws. repro documend ntains Idoctmon e n f o rv x o rt o f mu n it l n s o f w a r fm( jF Ia c t u r• o r u d wi hin/• re #ase •o fortg!n ntionar antt ~ne here•,E nýi• lfe, •a •t~ls ~ J hqjft fWst 9(ta in g anxoilic U#I•Ed Includ noiewiha y rerdue ali poto of tisdocument.n Accession For NTIS GRA&I E DTIC TAB STUDENT RESEARCH REPORT REPORT NUMBER AUTHOR TITLE 2750-81 MAJOR ALVIN L. YOUNG, USAF AGENT ORANGE AT THE CROSSROADS OF SCIENCE AND SOCIAL CONCERN FACULTY ADVISOR COLONEL GEORGE D. LATHROP. USAF, FACULTY COORDINATOR MAJOR RUMSEY H. USAF SPONSOR MR THOMAS R. HELMS JR., MC DASHIELL Submitted to the faculty in partial fulfillment of requirements for graduation. AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY (ATC) MAXWELL AFB, ALABAMA 36112 DISTR1BU1i7ffX n Approved for public r.*= J-"-"bu W106 Unwmm, - "", ... ~..S , SECURITY CLASSIFICATION OF THIS PAGE (W*en Doet Entered) READ INSTRUCTIONS REPORT DOCUMENTATION PAGE I. REPORT NUMBER 4. TITLE (and Subtitle) BEFORE COMPLETING FORM 2. GOVT ACCESSION NO. _-.0 2750-81i 7 9. S. TYPE OF REPORT A PERIOD COVERED . R _6, AUTHOR(s) ', RECIPIENT'S CATALOG NUMBER & Agent Orange at the Crossroads of Science and Social Concern# • 3. PERFORMING ORG. S. Alvin L. Young, PERFORMING ORGANIZATION Major, CONTRACT OR GRANT NUMBER(-) USAF NAME AND ADDRESS WC. PROGRAM ELEMENT. AREA Air Command and Staff College Air University Maxwell AFB II UNIT RROJECT TASK NUMBERS V rTE A/ A May 1981 UIMB ER OF PAGES AL 36112 63 MONITORING AGENCY NAME A AOORESS(IL dJ4*eent fewe Controlling Office) ]/ 6ORK 36112 CONTROLLING OFFICE NAME AND ADDRESS ACSC/EDCC Maxwell APB 14 AL REPORT NUMBER I /. IS. SECURITY CLASS. (of this ,epot) IS.. UNCLASSIFIED 'T.OELCLASSIFICATION'OOWNG-RAOING SCHEDULE 1. DISTRIBUTION STATEMENT (of this Report) OFFCIt •- t,' ,•'ALUSE Statenmnt "A" 17. DISTRIBUTION STATEMENT (of the abstract entered In Block 20, if different from Report) 1S SUPPLEMENTARY r9 NOTES KEY WOR-S (Continue or) reverse side it necesesry Agent Orange 2.4-dichlorophenoxyacetic acid (2,4-D) health effects 20 and Identify by block number) herbicides toxicity-human RANCH HAND Vietnam Veterans 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD or dioxin) 2.4.5-trichlorophenoxyacetic acid (2,4.5-T) ABSTRACT (Continue on reveres side If neceseary end Identify by block number) AThis report examines the question "Is Agent Orange responsible for health problems reported among Vietnam veterans?" A review is presented of the use of herbicides in South Vietnam and a •cdel is prcposed for objectively analyzing environmental health Although extensive scientific data are available on the issues. effects of Agent Orange and the dioxin contaminant, social, political, and legal concerns continue to drive the controversy.. DD "OjANl 1473 SECURITY CLASSIFICATION ;. / OF THI, "AG1 (Nh-n IeP e Fnfredl PREFACE For almost two decades, the United States Air Force has been involved in controversy over its tactical use of herbicides in Southeast Asia. The controversy centered first on the actual employment of herbicides in South Vietnam, then on the safe disposal of surplus herbicide following the conflict, and lastly, on whether herbicides were responsible for health problems reported among Vietnam veterans. Misinformation and emotion have characterized the controversy. This report was written in an attempt to clarify and place into a proper perspective many issues of the controversy. This manuscript will be submitted for publication in American Scientist, the journal of Sigma Xi, the scientific research society, The author is a major in the United States Air Force and serves as a herbicide specialist for the Department of Defense. He received the Bachelor and Master of Science degrees in Agricultural Science from the University of Wyoming. The Doctor of Philosophy degree was obtained in the specialty of Herbicide Physiology from Kansas State University. He has been associated with all facets of the Herbicide Orange Program since 1968. He has published two books on the subject and serves as a consultant on herbicides and dioxin issues for many governmental agencies. His primary research interest is in the environmental fate and toxicology of the phenoxy herbicides and their associated dioxin contaminants. The author acknowledges the suggestions and advice on science issues by Mr. Thomas R. Dashiell, Office of the Under Secretary of Defense for Research and Engineering, and Colonel George D. Timely Lathrop, USAF, MC, USAF School of Aerospace Medicine. contributions from reviewing the manuscript are also acknowledged from Lt Colonel William H. Wolfe, USAF School of Aerospace Medicine, Major Phillip Brown, HQ USAF/SGES, and Major A special acknowledgement is Rumsey H. Helms, Jr., ACSC. given to Mr. John C. Smith, ACSC Staff Communications Specialist, for his superb editorial assistance. *r r AGENT ORANGE AT THE CROSSROADS OF SCIENCE AND SOCIAL CONCERN by Alvin L. Is Young Agent Orange responsible for health problems reported among Vietnam veterans? The use of chemicals (herbicides) to control vegeta..on has been one of the most controversial subjects arising from the Vietnam conflict. jungle areas to clear vegetation from the peri- herbicides in meters of military bases and camps, and in tion, The US Air Force applied most of these enemy staging areas. along lines of communicaThe objective was to pro- vide defoliated zones that would reduce ambushes and disrupt enemy tactics. Orange," The most commonly used "defoliant" was "Agent a mixture of two commercial herbicides widely employ- ed for a number of years in brush control programs throughout the United States. During a five-year period from 1965 to 1970, the US Air Force applied more than 10 million gallons of Agent Orange in South Vietnam, and some two million American military person- nel served one-year tours during the same period. many veterans Recently, of that era have reported medical problems that possibly stem from exposure to Agent Orange during their tary assignments. in Their complaints have ranged from tingling the extremities to rare forms of cancer, have fathered children with birth defects. ft W" .'-- mili- and some veterans But overwhelming . scientific data on the toxicology of chemical components Agent Orange do not substantiate these claims. in Nevertheless, the news media has given intense sympathetic coverage to the veterans and their medical complaints. In the meantime, the Veterans Administration and the US Air Force have been directlong-term studies of mili- ed to conduct multimillion dollar, tary personnel allegedly exposed to herbicides in nam from 1962 to 1970. South Viet- whether actual or per- The issue is ceived health problems stem from herbicide exposure or whether other factors drive the controversy. Two key questions must be considered in sent concerns over Agent Orange. why is First, Orange issue surfacing 10 years after Second, it the Agent was used in Vietnam? can be used to insure an objective anal- what criteria ysis of such a complex, sensi- and politically controversial, One answer to the first tive subject? reviewing pre- question may be that presumed health effects from exposure to the herbicide have just now appeared or, at among Vietnam veterans. have recently been diagnosed least, Another possible answer is general public and Congress have the concerns just recently recognized of Vietnam veterans, a vehicle to focus those concerns. and bitterness over US involvement Americans to repress memories that the and Agent Orange is Certainly, in only the acrimony Vietnam drove most of that war. As a result, they have tended either to ignore veterans of the Vietnam 2 * ~- ..... era or to relegate them to a lesser status than veterans other wars. Recent gains in respectability of for Vietnam vet- erans have coincided with increasing American Interest in health and environmental issues. Thus, the controversy sur- rounding Agent Orange has surfaced primarily because volves the veterans and herbicides, it in- both of which have been the center of controversy since they were employed in Viet- nam. Health concerns herbicides, involving Agent Orange, Is (TCDD) date from 19?0. Current inte- merely an extension and popularization of issues first publicized in 1970 and again in 1974. A large volume of toxi- cological data on 2,4,5-trichlorophenoxyacetic and 2,4-dichlorophenoxyacetic es in component and the toxic dioxin contaminant 2,3,?,8-tetra- chlorodibenzo-p-dioxin rest its Agent Orange, US involvement in acid (2,4-D), acid (2,4,5-T) the two herbicid- were available during the final years of Vietnam, but woefully inadequate toxicolo- gical and environmental data on TCDD precluded resolution of the issues. Although scientists acutely toxic and teratogenic tory animals, recognized that TCDD was (birth in labora- no studies were available on the effects chronic long-term low-level exposures species. deforming) Furthermore, in of lower mammalian numerous occupational exposures to TCDD were reported during the industrial production of trichlorophenol, but human epidemiologic 3 1* _____7 studies were not available despite documented exposures as early as 1949. Thus, to resolve the present controversy, scientists presumably must determine whether they can assess the longterm effects of exposure to TCDD on the basis of existing data and whether the veterans' with the data. Of course, complaints are consistent one major assumption must be that US military personnel reporting health effects were probably exposed to Agent Orange and, hence, less of any reported health effects, clude examination of all to TCDD. But, regard- a valid study must in- facets of the controversy. This requirement poses a dilemma in any attempt to answer the second question because objective analysis depends on such an examination, but there are simply no modeis available for analyzing environmental health issues. In the absence of such models, examination of recent environmental crises involving other chemicals can provide a useful parallel for analyzing the Agent Orange controversy. For example, environmental contamination or "poisoning" epi- sodes during the decade of the seventies involved similar chemicals, such as chlorinated insecticides (chlordane, and mirex), polychlorinated biphenyls (PCBs). minated biphenyls (PBBs). and polybro- And, most recently, the Love Canal episode has received extensive publicity. of these episodes, and Culhane (13), DDT, Analysis including reports on PCBs by Hammond (19) reports on PBBs by Budd et al. (7), and '4 Ember's (17) assessment that these episodes share common characteristics. the public perceives episodes of the Love Canal episode, able events Apparertly, highly publicized environmental as threats to the "quality of life," of this perception, reveals the episodes ccAFnsrIng and, as a result lead to a number of predict- (see Table 1). Nature of Controversies A controversy involving environmental monly begins with an episodic event, contamination a specific instance Poisoning that arouses public and scientific an event usually begins with contamination Such of animals, but PBB episode, ulation, or contaminated however, is by, the chemical. In the This small pop- an inadequate sample for establishing Nevertheless, viduals respond to the event with lists in the event (e.g., only a few people or livestock are actually cause and effect relationships. effects improper use 7). Generally, exposed to, Its may have inadvert- Frequently, or disposal of the chemical precipitates cf concern. impact rapidly expands to include humans who ently been exposed to the chemical. cor- concerned of observed biological animals and adverse physical symptoms most instances, lay persons indi- in humans. (including news reporters), local physicians, or biologists compile these lists, ultimately become indicators of adverse effects to people who S51 and they I W)P 0) .1 C)0 0 .4'q +. 44-) U) C) ) C) C) -H 4-4 s- (4C) C)d10 CP Z -3 0.-H Z-0 02 C1) 'C) - 0 CD 094 Q4C) 5 HHOC)CD 10 Dz N m C) eQ) 0r4, HD a H-HW; 4 )-.P4H mDP, 04-P ca$-4 )+4-) C' 0 P -P 02 ) Q) 4--$0+ *HCP -40 -4 4-1P~H4 0 0H l 0 WO(D W'C) 4-1 a) .H r6 4-3 C) CDC ;4> 0 9 0 00 0d0 Q Q) -H C. Otl 10 -H-H ri HC-l 0 " a) >4- 0 ~ d C+', o M coDH -r4 ~toF b.0 ' r--U0PP "4-3+ 00 449Cd P4 Cd ( calG -.- Ic) 0-H 0 *4-*ý ) P9CZ S4 (V-H *H- -HO o 9 CO 4'1 4-b -)0 V) 4) oH1 c ,iV $-IW 0) ;: ý-i0 0 Ci ) 0~ FA ) w W+, + 0(D Pcd A a)rý 0 m 0 0 10 xi,~0O~~ 1 0 p Q) 4-1 4-14 C-H c US 0 C) Q) CD, U)-1 9 Q) 8 -d- CO 1 V H0 45' 00~ 2) 0 rfC. 04-)P S4 9 V -H- C) Q)~ E Ml £-H- MD 4-e4 -P IV I 4-1 -, r Q) Q) (1)C CO -H C)4--' P4 a > 4 -r-H 4 4+lW(1 .1H 0 Cr-q 03 43 -4 coý 9140 Q 0c n ) 0q p4 0 0 W4 -)-IdH,0 Q4 C -'-44 $EO )V ) 0 C)0-VPV 4>Q--t0-H' ý 1 a) 4-',4 b.0O k-C -4t)-H4-1 l0 4 Q) r1 d C0~C: 0 O3r-4 0 U WD 4-1 0 4> d 4 1-P td 0 r- -4 bD 0 0 0.-H -Hi CD HV mD H 0 9 t ) 0W 0 CD r4 Q) WV 0 2,0 -r (13 H?r-> C) co E-4 0 H H V2 4-)0 ~.ED Cd ~Pi; ~ * 91 0 l CD C.) p1 Ps C) pH~)0D CIJ Q) -,14~9 -f-'11-H (-4C m C *C (1 kO >.).HUCdp 04-91P40'd MJ: 0 -i q)r-4'd 0Cd -Ha 0q-H4 WC^4-l bCýý4C0C 1 4-~ttI0CD4-'jD 'Cd C) r+LI Q) Q) Q)0 r-4 4-2 -P 4-" CD -H1 -494-3 (D 44 Cd c -Hi -4iP z L *9 t 0 -l ") 'C0 04-4 ,0 C~ ýý-H p 0 +'4-l0C o M " 0 -144 M r-W0C) 4-4M 0 -,#W >- p 4-'>0 '-Q) V) C)(D-P 0P~- P P 4d 0 (a cW4)4- W -4-1 -HC)w w a ) mf 4-1 to,- !;, Q--C~ 0. Q) E Et P Qf) Q) fCd -cdId0 :SH, -r4pq --P44'-P (D4' '(d Cco& 4-12 Ell a) w -4 P 4+'Q )Cd (D rCd ~-Wd-H~ 4 P-H 0 C) -H 0 ~-4 0 e 0O 4-P CdW C1 ;AH ca) V 4-4 C r4 +34' CD 44 'dO (l P11- C)4WD H U) Q -H 4-4 C) -4- P4 C) H f-H ý4 C) 4'2 0 Cd1 p.- 4'ý CD-H -P.-r-4 z 4.1'1 -H a &2 C) C) co H- +) 4) Hi C) ) 'C) 0 m CD rl -P ? 0 .0 $: CD) o E-4 col a) 4 d (74 C) "d C col z CO 43 9 9 D0 ) A1 a) ~W d t 0 -,1 -H(DC 104.14 Q)WC(D 4 ~+3 0 -H A4- Cd A. H ) $3 C)'D d C 4-) z H- 1-4 Ea C -4wD CD pz H 14 4-450 aD) C P4 0 0 0 -Hri4- 0 4 C ( 4-2) a). C) 4 0 .4D *H 0 CD -H -PI -H M/ rf to) -H4 >r - 4-3 (t C) feel that they or their to the chemical. animals have been "potentially" exposed Invariably, with accepted scientific these lists are not consistent data because the media and the public either confuse or misunderstand the concepts of dose, and chronic and acute effects. As a result, the public con- cludes that the scientific Instances (e.g., data are inadequate, the Love Canal episode, 17), it an intense emotional reaction to the scientific pects that "contrary" Of course, it may express orientation. media compare the list In and, Initial the event usually contains many inaccuracies it sus- as such, coverage of and reflects a providing the coverage, of symptoms of a given episodic to symptoms from other similar events in other community. some data if "news," the local news media. highly emotional in data are wrong or even dishonest. the episodic event is always attracts and. exposure, the event the past or in some The intensity and duration of coverage de- pend on the magnitude or nature of the episode and on the number of people or animals exposed to "environmental poisoning." The media response Is further characterized by articles major newspapers or on the evening news, are usually followed by other articles stories in popular magazines Family Circle, Playboy, intense and frequently vision documentaries loop"- (e.g., In and these articles containing "sensational" Time, and Penthouse). Reader's Digest, Culmination of the inaccurate campaign is marked by tele- usually prepared to highlight significant events or chemicals. For example, "A Plague on Our Children" was televised nationwide on 2 October 1979 by the Public Broadcasting System In its "NOVA" series and focused in PCBs, TCDD, 2,4,5-T, and the Love Canal. Council for Agricultural Science and Technology (CAST, 12) reviewed this documentary and con- cluded: The program was overloaded with interviews with emotional laymen whose uneducated opinions about health hazards related to chemicals would be expected to induce a similar emotional response in the viewer. Following the episodic event and intense media coverage, numerous local, state, and federal agencies provide immediate but definitive responses to the stories. Personnel in these agencies are rarely knowledgeable about the chemicals or the incidents, but, after cursory reviews of available information and telephone calls to local scientists, physicians, or other "experts," they release tentative responses to implied or direct charges of official ineptitude. Frequently, the media and the public view these efforts as inadequate government behavior and label the concerned agency as "unresponsive." In concluding that the government is unresponsive, con- cerned citizens form special interest groups and usually solicit the services of their own "experts." Media coverage and inquiries to elected government officials prompt public hearings on the episodic event, the tragedies suffered by the 8 "victims," and reports by the scientific ment officials. lic community and govern- The impact of special interest groups on pub- attitudes and the behavior of government officials described by Ember ers Association, (17). For example, has been the Love Canal Homeown- a special interest group, launched a separate epidemiologic study of the Love Canal "at risk" population and subsequently used data derived from the study to elicit respon- ses from a number of federal agencies and even a US district court. Failure to resolve the controversy or to compensate victims of the episodic event soon leads to lawsuits against the company responsible for the event, chemical, suits is or for both activities. for production of the The real purpose of the law- to verify the concern of the individuals. complex nature of the issues precludes their ance on court dockets, and research institutions, immediate appear- special interest groups, academic and concerned citizens become involv- various facets of the chemical episode. confusion associated with so many "players," ment agency, Since the lawsuits are always "pending." Many government agencies, ed in the To minimize the the lead govern- usually a state health department, appoints an advisory group to insure maximum collection and review of all relevant data. credentials The composition of this group must reflect the of "qualified" people representing major players 9 and various government agencies involved In major function of the advisory group Is that will assist the lead agency In the episode. One to offer recommendations resolving the issues. With the possible exception of bans on some of the chlorinated insecticides, the government and the scientific have satisfactorily resolved very few episodes stemming from environmental poisoning. sionate scientific in But, even in community the ban on DDT, data took second place to emotional concerns the legal resolution of the issue (15). These controversies generally remain unresolved because there simply is no satisfac- tory mechanism for treating opposing points of view in "quality of life" issues. public fear of artificial of confidence in the ability The result chemicals in the environment and lack or willingness of government and unsatisfactory resolution is teristic complex has been an increasing science to resolve problems related to their Thus, dispas- still use or disposal. another unique charac- of controversies stemming from environmental poisoning episodes. Obviously, the characteristics that distinguish environ- mental poisoning episodes from other environmental issues are scientific, social, political, and legal. If a controversy is based on a preponderance of scientific concerns and these concerns cannot be resolved to the satisfaction of the media and the public, then one can reasonably conclude that scientific 10 issues drive the controversy. answers to key scientific In this initial controversy. social, political, all studies suffi- In but they may not resolve the such instances, one must conclude that or legal issues drive the controversy. key scientific political, parties, and legal concerns. involving relatively and the same is Thus, small expenditures might be feasible to enhance the existing scientific On the other hand, decisions in Ob- questions can never be answered to the complete satisfaction of all for social, On the other hand, data may permit definitive answers to ques- tions related to public health, viously, K reasonable questions should lead to satisfac- tory resolution of the controversy. cient scientific instance, true short-term of resources data base. a reasonably complete data base for making the present or immediate future may not justify long-term studies (years) requiring major outlays of dollars and manpower. The nine characteristics apply in discussed in varying degrees to all controversies based on envi- ronmental poisoning episodes. Like other controversies, Agent Orange controversy can be examined in this model. events: However, the first of herbicides the the framework of The analysis begins with an evaluation of the episodic event and traces its versy. the above model in evolution to a full-blown contro- Agent Orange may have produced two episodic and, perhaps, South Vietnam, 1i major event was military use and the second event may well have been the initial Vietnam veteran in publicity given to the herbicide March 1978. Military Use of Herbicides In May 1961, in South Vietnam the Office of the Secretary of Defense re- quested US Army personnel at Fort Detrick, mine the technical feasibility in Vietnam. early fall Maryland, of defoliating This request followed complaints advisors that and the to deter- jungle vegetation from US military jungle vegetation supported enemy ambushes. 1961, scientists ducted 18 different aerial and government officials defoliation involving various formulations By had con- and anticrop tests of commercial herbicides near Saigon. They selected the herbicides of their extensive use and research in primarily on the basis the United States, but they also considered such factors as available quantities, and known or accepted toxicity to humans and animals. costs, The tests showed that two different mixtures of herbicides would produce significant ture, defoliation and anticrop effects. code-named "Purple," The first consisted of the n-butyl esters of 2,4,5-T and 2,4-D and the iso-butyl ester of 2,4,5-T. ond mixture, mix- code-named "Blue," The sec- consisted of a powdered formu- lation of cacodylic acid mixed with water. Agents Purple and Blue were received at Base on 9 January 1962 and were the first Operation RANCH HAND, Tan Son Nhut Air herbicides used in the name given to the tactical 12 project for aerial spraying of herbicides. of 2,4,5-T (Pink and Green) were received in and evaluated during the first HAND. By early 1965, Two additional formulations limited quantities three years of Operation RANCH two other herbicides, code-named Orange and White, had been evaluated and brought into the spray pro- gram, in and, the same year, Agent Blue was changed to a uid formulation of cacodylic acid, need for mixing operations. liq- thereby eliminating the Agent Orange replaced all formula- tions of agents Purple and Pink and eventually became the most widely used military herbicide in et al., 41, and Bovey and Young, South Vietnam. 6, (see Young for additional early his- tory of the RANCH HAND program). All herbicides 55-gallon steel for military use were shipped to Vietnam in drums coded with colored bands painted around the center of the drums. These bands identified the herbicide and thus helped personnel unfamiliar with the chemical composition and properties of the herbicides to avoid mixing incompatible herbicides (e.g., Blue with White). Agent Orange was a reddish-brown in liquid that was soluble diesel fuel and organic solvents but was insoluble in water. One gallon of Orange contained 4.2 and 4.4 pounds of the active ingredients 2,4-D and 2,4,5-T, respectively, as a 50:50 mix- ture of the n-butyl esters of 2,4-D and 2,4,5-T. was a dark brown viscous liquid that was soluble Agent White in water but 13 ~. -. ~ ~ . lw was insoluble in diesel fuel. One gallon of White contained 0.54 pounds of the active ingredient 4-amino-3,5,6-trichloroplcolinic acid (picloram) and 2.0 pounds of the active ingredient 2,4-D. This agent contained a propanolamine salts 1:4 mixture of the trilso- of picloram and 2,4-D and was sold in the United States under the commercial name Tordon 101. Agent Blue was a clear yellowish-tan liquid that was soluble in water but was insoluble in diesel fuel. One gallon of Blue contained 3.1 pounds of the active ingredient cacodylic acid, total formulation, organic arsenical. and, of the 15.4 percent was arsenic as the pentavalent Agent Blue was similar to Phytar 560, a commercially available organic arsenical sold in the United States. As noted earlier, all of the herbicides ultimately used In South Vietnam were not consistently applied throughout the 10-year period (1962-19?1) program. Furthermore, encompassed by the DoD defoliation 2,4,5-T formulations used early in the program probably contained higher levels of the toxic dioxin contaminant TCDD than later formulations. Levels of TCDD in Orange were low because of subsequent improvements in production and quality sontrol. -- n be diif f c-. The three periods shown In Table 2 h-is31 of sz !fic herbicides used anI the mean dioxin content of herbicides containing 2,4,5-T. 14 Table 2. Differentiation of Three Time Periods During US Military Defoliation Program in South Vietnam and Mean Dioxin Content of Herbicides. Herbicides Used Period (Code Names) Mean Dioxin Content (parts per million)* January 1962June 1965 Purple, Pink, Blue July 1965June 1970 Orange White, Blue 2*** 0 July 1970October 1971 White, 0 Green Blue *Found only in 2,4,5-T containing formulations. **Value based on the analyses of five samples. ***Value based on the analyses of 488 samples. SOURCE: Young (40). 15 32** 0 Agent Orange, the most extensively used herbicide, ed for approximately 10.7 million gallons 17.7 million gallons of total (Table 3). However, (60 percent) herbicides used in accountof the the conflict Table 3 shows that Orange was not the only herbicide containing 2,4,5-T in quantities of agents Purple, the defoliation program. Pink, Small and Green containing 2,4,5-T and the dioxin contaminant were used from 1962 through mid-1965. Patterns of Use Each of the three major herbicides (Orange, White, and Blue) had specific uses although they were applied at the same rate of three gallons per acre. White was applied in Ninety-nine percent of Agent defoliation missions, but it on crops because of the persistence of picloram in was not used the soil. The slow action of White on woody plants usually delayed full defoliation for several months after Thus, it was an ideal herbicide for use in rapid defoliation was not required. occur, application of the spray. it inland forests where But, when leaf fall did persisted for longer periods than following use of agents Orange or Blue. Agent Blue was the herbicide chosen for missions requirIng destruction of cereal or grain crops. cent of all Approximately 50 per- Blue was used to destroy crops in controlled areas, remote or enemy- and the other 50 percent was used as a contact herbicide for controlling vegetation on base perimeters. 16 At the Table 3. Code Name Number of Gallons of Military Herbicide Procured by the US Department of Defense and Disseminated in South Vietnam During January 1962 - October 1971. Herbicide Orange 2,4-D; 2,4,5-T White Quantity Period of Use 10,646,000 1965-1970* 2,4-D; Picloram 5,633,000 1965-1971** Blue Cacodylic Acid 1,150,000 1962-1971** Purple 2,4-D; 2,4,5-T 145,000 1962-1965 Pink 2,4,5-T 123,000 1962-1965 Green 2,4,5-T 8,200 1962-1965 17,705,200 Total *Last fixed-wing mission of Orange 16 April 1970; last helicopter mission of Orange 6 June 1970. **Last fixed-wing mission 9 January 1971; all herbicide missions under US control stopped 31 October 1971. (41). Young et al. SOURCE: 17 S~17 rate of three gallons per acre, Blue caused a noticeable brown- ing and desiccation of leaves within a period of one day, ticularly on the tall perennial grasses par- that grew on the peri- meters of many military bases and camps. Ninety percent of all defoliation, was used in ramie, use' Agent Orange was used for forest especially the mangrove forests, and eight percent the destruction of broadleaf crops and root or tuber crops). on base perimeters enemy cache sites, (beans, peanuts, The remaining two percent was (primarily around RANCH HAND bases), on and around waterways and communication lines. (Table 4 shows three major categories of vegetation and the num- ber of acres sprayed with herbicides.) Certain portions of South Vietnam were more frequent targets for defoliation missions because of the unique requirements imposed by military operations. Table 5 shows herbicide zones, expenditures for the four combat tactical and Figure I shows the location of the defoliation operations in population areas and the combat tactical These data were obtained primarily from the HERBS tape zones. (a relation to of computer listing herbicide missions in South Vietnam from 1965 through 1971). Figure 1 shows the locations of all defoliation missions. Dissemination of Herbicides Although numerous aircraft over Vietnam, only a were employed in few of these aircraft 18 the air war were used for aerial Table 4. The Number of Acres Treated with Military Herbicides in Three Major Vegetational Categories in South Vietnam, 1962-1971. Vegetational Category Acres Treated* Inland Forest 2,670,000 Mangrove Forests 318,000 Cultivated Crops 260,000 Total *Acres receiving single or multiple coverage. SOURCE: NAS Report (I0). 19 3,248,000 Table 5. US Herbicides Expenditures in South Vietnam, 1962-1971: A Breakdown by Combat Tactical Zone.* Combat Tactical Zones Herbicide Expenditure (gallons) Orange White Blue CTZ I 2,250,000 363.000 298,000 CTZ II 2,519,000 729,000 473,000 CTZ III (includes Saigon) 5,309,000 3,719,000 294.000 CTZ IV 1.227.000 435,000 62.0o0 11,305,000 5,246,000 1,127,000 Subtotals Grend Total *SOURCE: 17,678,000 HERBS tape and Young (40). 20 SOUiTH VIETNAM 4 DEFOLIATION MISSIONS f CTZ I JANUARY 1965 - FEBRUARY 1971 - 6 Mision. track Popolated Greg -' /1' 1A1 CTZ II 7. 4161 Figure 1. The Location of Defoliation Missions in South Vietnam from January 1965 to February 1971. The Data for the Mission Tracks are taken from the HERBS Tape. Source: NAS (10). 21 aissemination of herbicides. The "work horse" of Operation called the "Pro- RANCH HAND was a two-engine C-123 aircraft vider," a cargo aircraft modular spray system. tank, pump, adapted for internal carriage of a The module consisted of a 1,000-gallon and engine mounted on a frame pallet. An operator's but it was not mounted integral part of the unit, console was a Wing booms extended from the outboard engine on the pallet. nacelles toward the wing tips, tioned centrally near the aft sion, cargo door. During a typical mis- sprayed herbicides at a speed of 150 miles the aircraft per hour at boom was posi- and a short tail a height of 150 feet above the ground, treetop level over the triple canopied were adapted for aerial C-123 aircraft often at Although 33 jungle. spraying and all of the were employed during the peak period of RANCH HAND aircraft operations (1968-1969), many other squadrons of C-123 aircraft were not adapted for these operations and were routinely employed throughout South Vietnam for combat support operations. The control of malaria and other mosquito-born diseases application of necessitated an extensive program for aerial Insecticide to control these vector insects. Some combat troops experienced malaria rates as high as 600 per 1,000 per year in 1966 (26). Thus, UC-123K aircraft gallons from 1966 through 1972, were used to disseminate more than 400,000 of malathion, the aircraft three RANCH HAND an organophosphate insecticide. designated for spraying herbicides, 22 Unlike these aircraft were not camouflaged, and they routinely sprayed insecticide adjacent to military and civilian installations and in where military operations were in progress or about to com- mence. The insecticide took the form of a white fog composed of minute droplets that settled opy, areas but herbicides very slowly on the jungle can- were applied as large droplets that fell rapidly on the canopy with minimal drift. In addition to the C-123 aircraft, helicopters and ground application equipment disseminated approximately cent of all ces. herbicides used in South Vietnam. In 10 to 12 permost instan- the UH-1 series of helicopters were used to apply the herb- icides. They carried spray units consisting of 200-gallon tanks and collapsible 32-foot spray booms that could be installed or removed in or a matter of minutes. Most of the ground delivery systems were used to control vegetation cles. in limited areas and were towed or mounted on vehi- One routinely used unit was the buffalo turbine, which developed a wind blast up to 150 miles per hour at 10,000 cubic feet per minute volume. into the air blast, it Thus, when the herbicide was injected was literally shot at the foliage. unit was particularly useful for spraying agents Blue and Orange alonq roadsides and on perimeter defenses. Exposure Considerations Relatively few military operatlons directly involved 23 This r -II military personnel in operations 1970, handling herbicides. For example, in involving Agent Orange from January 1965 to April three groups of United States military personnel may have been exposed to Agent Orange and its contaminant associated dioxin (40): 1. Personnel assigned directly to Operation RANCH HAND and actively involved in defoliation program - aircrew members and maTaintenance and support personnel. 2. Personnel assigned to selected support functions that may have resulted in exposure to Agent Orange. Included in this group are personnel who sprayed herbicides from helicopters or ground application equipment, personnel who may have delivered the herbicides to units on defoliation missions, drum handlers, aircraft mechanics who occasionally provided support to RANCH HAND aircraft, or personnel who may have flown in contaminated C123 aircraft but were not assigned to RANCH HAND. During the Tet Offensive, for example, all RANCH HAND aircraft were reconfigured to transport supplies and equipment and were assigned to non-RANCH HAND squadrons. 3. Ground personnel who may have been inadvertently sprayed by defoliation aircraft or who may have entered an area previously sprayed with Agent Orange. The total Agent Orange is number of US military personnel exposed to not known. Although approximately 1,200 RANCH HAND personnel were exposed to herbicides support of defoliation missions, through direct there are no data on the number of non-RANCH HAND personnel who may have been exposed Orange or other herbicides. to Agent But,since numerous helicopters were 24 equipped with spray units, nel may be in the actual number of exposed person- the thousands, vehicle-mounted and most major military bases had and backpack spray units available primarily for spraying Agent Blue in routine vegetation control programs (40). There are no available figures on the number of military ground personnel who may have been sprayed inadvertently aircraft by RANCH HAND or who may have entered areas sprayed with Agent Orange during combat operations. Although approximately South Vietnam was sprayed with herbicides, led most of this area. generally remote, Nevertheless, 10 percent of enemy forces control- unpopulated, and forested deployment of US military forces through- out South Vietnam increased the likelihood that combat personnel may have entered areas sprayed with herbicides. the headquarters Figure 2 shows locations of most major US Army units deployed during the period of heavy defoliation activities (1968-1969). Summary of Herbicide Use In discussing the use of herbicides Young (40) South Vietnam. noted that an estimated 107 million pounds of herbi- cides were aerially January in disseminated on three million acres from 1962 through October 1971. the herbicides Approximately 94 percent of included the phenoxy herbicides 2,4-D (56 million pounds or 53 percent of the total) and 2,4,5-T (44 million pounds or 41 percent of the total). The 44 million pounds of 2,4,5-T contained an estimated 368 pounds of the toxic dioxin contaminant. Agent Orange contained ninety-six percent of all 25 2,4,5-T, QULANG:ENA Figure~~~~~~~~~~~~~ D8oiino.MjrUryUis2. Sourc: GAORepor nSuhVenm (18) 26[ % AV.. . . . . . . and agents Green, Pink, However, four percent. and Purple contained the remaining agents Green, and Purple contain- Pink, ed approximately 40 percent of the estimated amount of TCDD disseminated in South Vietnam, and these agents were sprayed as dea foliants on less than 90,000 acres from 1962 through 1964, period when only a small force of US military personnel were deployed in taining the region. Agent Orange con- Ninety percent of all 39.3 million pounds of 2,4,5-T and 203 pounds of TCDD was used in defoliation of 2.9 million acres of inland forests and mangrove fcrests. Procedures for handling, transporting, and storing the drums of herbicides generally precluded physical contact by most military personnel. However, the most likely exposed personnel were assigned to the RANCH HAND squadrons and to helicopters Claims responsible for disseminating the herbicides. of Adverse Health Effects publi- Apparently released to the press prior to scientific cation, in a preliminary report by the National Cancer Institute 1968 noted that samples of 2,4,5-T were found teratogenic laboratory mice. While the American press reported the terato- genicity of 2,4,5-T in laboratory animals, South Vietnamese news- papers published reports of birth defects in Agent Orange. in These reports elicited from governmental agencies, areas sprayed with far-reaching reactions segments of the scientific and various lay groups concerned with environmental 27 community, problems (39). In late October 1969, the the Department of Defense restricted use of Agent Orange in Vietnam to "remote and unpopulated" areas. Additional animal experiments 1969 and early 1970 led to in the conclusion that the dioxin contaminant marnly responsible for deformities In 2,4.5-T was pri- the offspring of laboratory in Never- mice following exposure of the females to the herbicide. theless, the question was whether or to wftat extent animal data could be extrapolated to man Concurrent (39). sion of many uses of 2,4,5-T herbicide in with the suspen- the United States, in use of Agent (range Department of Defense suspended all the South Vietnam on 15 April 1970. initially A select group of highly visible scientists objected to all use of herbicides vidually and collectively, articles for newspapers reports of birth same scientists tical defects in published their views in and popular magazines appeared in first were instrumental in indi- the Vietnam war and, (6). numerous And, when the news media, the mustering public and poli- opinion against continued use of Orange. Thus, termination of the RANCH HAND program and use of Agent Orange occurred during an environmental controversy focused on health issues, and the "controversy was compounded by strong anti-Vietnam sentiment among members of the press and the general public. But concern for the health of Vietnam veterans exposed to Agent Orange did not reach its peak until eight years later. "28 Evaluation of the Science To understand the role of science and its government regarding 2,4,5-T since it Vietnam. tection Agency (EPA) 1970, tists In South the newly formed Environmental Pro- embarked on lengthy administrative of banning all inqs to determine the feasibility of 2,4,5-T. used in was last imposed limits on the use of After the government 2,4,5-T herbicide in review actions of the one must first Agent Orange controversy, on the influence remaining uses reviewing the use of 2,4,5-T and TCDD, pursued investisetions in proceed- two different areas. area dealt with the toxicology of 2,4,5-T and TCDD in scienThe first animals, and the second area included an evaluation of available data on human health effects and potential routes herbicides and TCDD. These studies confirmed the availability of significant toxicological very little data on TCDD. proceedings to cancel in large scientifically of exposure to phenoxy in data on 2,4,5-T, Consequently, but they reported the EPA withdrew from June 1974 since "evidence which would part determine the outcome of these proceedings remains unavailable again issued notices (31)." In December 1979, the agency of intent to hold a hearing on whether to cancel all registrations of 2,4,5-T. The hearing began in March 1980 to explore the risks and benefits associated with the registered uses of 2,4,5-T, and it writing (February 1981). 29 is still in progress at this Toxitology of 2,4,-T and TCDD in Diaz-Colon and Bovey (16) Animals report that more than 870 toxi- cological studies of the phenoxy herbicides in the past 25 years. Kociba et al. (21) readily absorbed, And, in have been published a summary of the data on 2,4.,5-T, note that it is moderately toxic to mammals, and rapidly excreted. In a two-year study of chronic toxicity and oncogenesis among rats ingesting diets containing 2,4,5-T, they found few toxicological symptoms body weight and slight and lungs) rats et al. livers, (30 mg 2,4,5-T/kg re- even when administration of 2,4,5-T extended life span at a dosage high enough to induce As for the effects (32) kidneys, This study also revealed no oncogenic over most of their toxicity. changes in even at the highest dose level body weight/day). sponse in morphological (loss of found in of 2,4,5-T on reproduction, studying three generations of rats Smith that dose levels of 2,4,5-T high enough to cause signs of toxicity had no effect on the reproductive capacity of rats, except for a tendency to reduce neonatal survival at dose levels of 10 and 30 mg/kg/day. Although the above animal data suggest that 2,4,5-T poses few toxicological problems, the contaminant TCDD is far more toxic. It indeed, the amount required to cause a teratogenic effect of has been scientifically some kind is In this confirmed as a teratogen; far lower for TCDD than with many other compounds. sense, it is one of the most potent compounds studied 30 in the laboratory teratogenic (30). Qualitatively, than many other chemicals: commonly associated with TCDD is cleft however, it is far less the teratogenic response palate. It tends to cause death of the embryo or fetus rather than a wide range of abnormalities, claim that it and, for this reason, causes miscarriages many environmental groups in women as a result ing forests with contaminated 2,4.,5-T. But it note that the teratogenic action of TCDD is (i.e., it occurs in species, mice and rats reports that scientists rats, important to species specific but not in including rhesus monkeys). is of spray- other laboratory Furthermore, (39) Tschirley have found TCDD a potent teratogen in but an apparent no-effect level was 0.001 mg/kg/day, a level 10 times below the demonstrated no embryo-toxic effect level in rhesus monkeys. A review of the published literature a carcinogen for rats and mice. In reveals that TCDD is a two-year study of chronic toxicity and oncopenicity resulting from TCDD (2,3,7,8-TCDD), Kociba et al. (20) found that doses of TCDD sufficient to in- duce severe toxicity increased the incidence of some types of neoplasms (both liver dence of other types, uterus, and pancreas. creases in slight and lung) in rats but reduced the inci- such as tumors of the pituitary gland, During their study, they found no in- tumors among rats receiving sufficient TCDD to induce manifestations of toxicity. 31 Current studies of mutagenicity have not found that 2,4,5-T is a mutagen in animal test shown that TCDD is city (33). In September 1980, Experiments have two bacterial reverse mutagen a mutagen in but they have found no in systems, (33). systems of mutageni- vivo correlates Lamb, Moore, and Marks experiment ported the results of a reproduction and fertility male mice treated with the three chemical constituents cern in Agent Orange (2,4-D, significant decrement in evidence of toxicity in 2,4,5-T, the fertility germ cells. and TCDD). re- (23) on of con- They found no or reproduction and no Survival of offspring and neonatal development were apparently unaffected by paternal exposure to simulated mixtures of Agent Crange. community has not validated a quantitative The scientific method of extrapolating animal data to the human situation. Nevertheless, the significance of the above data is that most of the adverse effects expected from severe exposure to 2,4..5T contaminated with TCDD will probably be due to the TCDD. though TCDD is as cleft or fetus. a teratogen, palate in Exposure tive problems. Al- the effects are primarily manifested offspring or through lethality of the male is As a carcinogen, of the embryo not likely to cause reproduc- TCDD can be expected to cause neoplasms of the lungs and liver, but suggestions of no-effect levels for TCDD as either a teratogen or carcinogen make the magnitude of exposure a critical factor in long-term adverse effects. 32 considering possible Evaluation of Human Health Effects reports of human birth defects attributed to The first Vietnamese newspapers Agent Orange appeared in reports, furor caused by these of the public and scientific As a result Cutting et al. two independent (14) June 1969. in and Meselson et al. (24) surveys of South Vietnamese hospital records. Although neither report reached definite conclusions of the accusations, validity conducted on the both reports acknowledged that searches of the records probably would have revealed any marked increase in birth defects or introduction of a striking defect, such as the defects produced by thalidomide. in Subsequent re- 1971 and Rose and Rose (28) ports by Tung et al. (34) centered on clinical observations and interviews in South Vietnam. births were reported for humans at,, In 1973, Tung et al. (35) 1972 conducted in Hanoi with refugees who claimed that they were repeatedly ed with defoliants in spray- Abortions and monstrous &on .nimals. 7ti. compared the number of cancer patients admitted to Hanoi hospitals during the period from 1962 to 1968 with the number admitted from 1955 to 1961, period prior to the spraying of herbicides. increase In They reported an the number of persons with primary liver proportion to patients with other types of cancer. concluded that this increase was the result bicides containin7 TCDD, 33 C.- cancer in The authors of exposure to her- but they could not document histories of actual exposure. the individual In South announcing the results of studies conducted in Vietnam In a committee appointed by the 1972 and 1973 (10), National Academy of Science (NAS) reported that it could find no conclusive relationship between exposure to herbicides and birth defects humans, in records were not adequate for definite conclu- available birth The committee also could not confirm or deny reports sions. especially the Montagnards, that some humans, cide sprays or after nated water. president In and domestic they were exposed to herbi- or died after animals became Ill ance, but the committee recognized that they consumed treated plants or contami- a letter of the National Academy of Science stated: the untoward effects the of transmittal for the report, bal- "On of the herbicide program on the health of the South Vietnamese people appear to have been smaller than one might have feared". It is to find precise extremely difficult cerning the adverse effects of 2,4-D, mans. and TCDD in accidents, but there is suicidal gestures, Rnd indus- a great deal of confusion concern- ing the presence of long-term effects. Much of the medical knowledge concerning the effects of 2,4-D and 2,4,5-T is from case reports. derived Since many of the patients described in these reports were exposed to multiple chemical agents, difficult hu- Acute and subacute effects are reported quite uniformly following accidental exposures, trial 2,4,5-T, information con- it to determine the chemicals that produced specific 34 is -' symptoms. Of the vast array of symptoms attributed to 2,4-D, the most consistently reported problems involve havior, the nervous system, the liver, personal be- and tho int-stines (38). Medical data associated with exposure to 2,4-D come pribut data for 2,4,5-T and TCDD incidents, marily from spraying duction of 2,4,5-T, numerous exposure to trichlorophenol, 23 episodes recorded in sults of occupational industrial episodes h1,ve involved 2,'ý,5-T, were apparently the re- exposures during Industrial production on eight occasions, But, exposed during cleanup following explosions contaminated workshops (41). personnel were or to Imoroperly de- Unfortunately, the effects of these episodes could not be clearly distinzuished 2,4.5-T in Symptoms attributable to from the possible effects of TCDD. 2,4,5-T and TCDD exposure include all in dermatitis. of the symptomns addition to skin disease, Many scientists chloracne, Chloracne is (blackheads) cysts or papules frequently terminating that they cause permanent similar to teenage acne, scarring. is but it 35 in is the "hall- espec.,,lly 2,3,7,8- a skin reaction characterized dermatitis composed of comedones of 2,4-D or acniform believe that chioracre mark" of exposure to the dibenzo-p-dioxins, TCDD. Fifteen of the and TCDD. the literature of chlorinated phenols. exposure, cornercial pro- Since the first come from industrial exposures. and '-y a general inclusion pustules so severe Morpholo.ically, more severe, it is particularly on the upper face, been reported ears, and neck. many years after Active chloracne lesions have exposure to TCDD. tion usually clears up spontaneously in but the condi- a few months. aging of involved skin areas has been reported in Premature some instances. Several case control epidemiology studies conducted by Swedish scientists have reported evidence of a statistical tionship between cancers of soft tissues and exposure to the phenoxy herbicides and TCDD (5). (35) cited earlier scientific rela- And the data by Tung et al. has received widespread attention, but the community has viewed these studies with caution. for angiosarcoma, and irrefutable Except a rare type of cancer caused by vinyl chloride exposure, it is virtually impossible on a individual basis to distinquish between a cancer caused by a specific chemical agent and a similar cancer caused by some other etiology. Four recent research studies may provide important clues concerning the effects of exposure In January a thirty 1980, to Agent Orange or dioxin. Zack and Suskind (42) published the results of year follow-up study of 121 chemical workers who had developed chloracne accident at Nitro, apparent excess in following exposure to TCDD in West Virginia. Although they observed no total or in cardiovascular disease, clusive because an industrial mortality deaths from cancer or they could not consider the results of the small cohort and the relatively number of deaths observed. In October 1980, 36 con- small Zack and Gaffey (2) expanded this study to include 885 men, alive and 164 had died. excess in total systems. Analyses of these data also showed no deaths or in diseases of the nervous, deaths caused by cancer or other circulatory, Although most of the men in did not develop chloracne, phenol plant and, Cook et al. (11) hence, of whom 721 were still respiratory, or digestive this larger population they were employed in the trichloro- were exposed to TCDD. In August 1980, reported on a study of 61 males involved in chloracne incident at Midland, Michigan, in 1964. of these men developed chloracne while working in a Forty-nine a trichloro- phenol manufacturing plant operated by Dow Chemical Company. Within the limits imposed by the size of the cohort and the length of the follow-up, TCDD apparently had no adverse effect on mortality experience, and deaths from cardiovascular disease or cancer were statistically 1981, the company (3) insignificant. And, released a report on its in January study of the off- spring of production workers exposed to 2,4,5-T and TCDD. The study was based on an interview questionnaire administered to 370 wives of men who had worked in areas where they could have been exposed to TCDD and to a control group of 345 wives of men in the same division (Midland, in such areas. Michigan) The study found no statistically differences between the two groups in stillbirths, who had never worked infant deaths, instances significant of miscarriages, or congenital malformations. 37 In other words, there are no epidemiologic data associathumans other than ing TCDD with any long-term health effects in chloracne, but, as noted by Wolfe (38), neither is evidence to validate the absence of such effects. there strong Most studies have not included sufficient numbers of subjects to detect increased risks of uncommon conditions, and the period of observa- tion in many studies has been inadequate to detect conditions with long lag times between exposure and illness. There is currently no reliable evidence that links dioxin exposure to cancer or birth defects in humans. The Scientific Data and the Veteran Complaints Sauri (29) examined the first 361 claims submitted to the Veterans Administration from 1977 through April 1979 by Vietnam veterans claiming disabilities from exposure to herbicides. These claims described 130 different effects in gories of symptoms: peripheral neuropathy, psychiatric, dermatologic, five major catereproductive, and cancer. The scientific data validate specific links between exposure to Agent Orange and TCDD in the sense that symptoms reported by the veterans have also been documented in cases of exposure to the herbicides or to TCDD. these symptoms, e.g., peripheral neuropathy, loss, and some psychological disturbances, But most of fatigue, weight are acute symptoms that manifest themselves shortly after exposure. 38 other Similar symptoms arising years after the last exposure are most likely caused by an etiology other than 2,4-D and 2,4,5-T. majority of the veterans claimed dermatological The vast problems, but only three of the claims cited chloracne and none could be confirmed by physical examination. Further evaluation of the early claims revealed that many claimants were males who reported fathering deformed children. The review of the scientific was a teratogen in effects literature laboratory animals, acknowledged that TCDD but the studies described resulting only from female exposures. Recent studies of reproduction among male mice exposed to 2,4-D, 2,4,5-T, and TCDD do not confirm an increased incidence of birth defects. as noted earlier, cleft palate is And, the birth defect associated with exposure of pregnant female animals to TCDD. The children reported on the claims suffered a wide variety of deformities. Seven percent of the claimants reported a variety of malignancies, but there is currently no valid evidence linking expo- sure to 2,4.,5-T and TCDD with instances of cancer. number of people in The limited the cohort precludes any definite link be- tween rare forms of cancer and exposure to TCDD or to the phenoxy herbicides. Despite the preponderance of scientific data that contradict the veterans' allegations, one recognizes that some of the veterans have definitely experienced health problems. Conclu- sions based on scientific analysis of the available data in no 39 , •-•• • way denigrate these problems. The purpose of this determine whether Agent Orange is If Agent Orange is responsible not responsible, to for the problems. then some other factor associated with the Vietnam war may be responsible, the symptoms are afflictions study is or, perhaps, of aging and attendant psycho- social aberrations. The Role of Social, As mentioned earlier, social, political, Political, and Legal Concerns a number of factors - scientific, and legal - have an impact on public and pri- vate perceptions of controversial issues. When these percep- tions are manifested as fear of the unknown, associated with a poisonous chemical in such as the risk the environment, the public does not always react to that fear in proportion to the seriousness of the threatened harm. particularly of "quality of life" issues in volves value choices. political, Thus, true which determination of risk In- Positions taken by the media and the courts may be independent of scientific actual risk. This is in consensus regarding the addition to scientific factors, social, and legal "perceptions" have a direct impact on the issues that drive the Agent Orange controversy. Intense Media Campaign Station WBBM, a television affiliate Broadcasting System in in Chicago, March 1978 on the subject, Fog." Illinois, of the Columbia aired a special report "Agent Orange: Vietnam's Deadly This film reviewed a number of past environmental 40 II episodes allegedly involving 2,4,5-T and TCDD. the WBBM reporter, veterans in Kurtis (22), compared symptoms described by some Vietnam the Chicago area with the symptoms past "poisoning" episodes. Veterans shown In identified in the film claimed that they had been sprayed with Agent Orange during combat operations in South Vietnam. Kurtis concluded his documentary with these statements: Officially the Veterans Administratioi: is denying the claims of poisoning by Agent Orange. Their scientists simply feel there isn't any evidence to link defoliation with human problems. But after researching this report and listening to the recommendations of the leading dioxin scientists in the country, we feel there is a need for immediate testing of all Vietnam veterans who handled Agent Orange or went into sprayed areas. Not only for the sake of those who have told us of their symptoms but for the countless others whose lives and whose childrens lives could be blighted by the dioxin poison in Agent Orange. Numerous magazine reports and serialized articies in news- papers have been published throughout the country since that time. is Therefore, in analyzing the Agent Orange controversy, not too unrealistic in nited the controversy. stating that two enisdIic As mentioned earlier, was the military use of herbicides second was the initial 1978. in -vents ig- the first South Vietnam, event and the publicity given to the issue i Some newspaper articles are factually based, are based on emotionally charged personal tragedies presence of terminal cancer in a young veternn). 41 one March but many (e.g., Wade (37) the i and wrote that the recently reviewed many of these articles "whole passel" of apprehensions "may have nothing to do with Agent Orange In fact, scientific but is grounded in other prob- lems affecting the Vietnam veteran population and has been launched into celebrity by a self-generating series of press and television stories." He observed further: In favor of the latter be noted that the first veterans' hypothesis, it may large batch of complaints about Agent Orange emerged in 1978 from Chicago shortly the showing there of a television after about the herbicide's possible documentary The idea spread like effects on health. wildfire among veterans' groups; here at last was a tangible cause for all their generated Each claim filed discontents. more newspaper stories which generated further claims, until the present fervid atmosphere had been created. Farrows (8) cites the following four problems in reporting on scientific and environmental subjects: Reporters almost always work under severe 1. The task of gathering a time limitations. deal of information on complex subjects great and converting it into decent prose In a matter of hours can be a formidable challenge. 2. Abnormal rather than normal conditions By definition, newsworthy are newsworthy. items are unique or rare events, developments, and issues of interest to relatively large numbers of people. Problems of time "Objectivity" is a myth. pertinent all of inclusion prevent and space Thus, the very information in major stories. act of omission, not to mention placement of 3. material and points of emphasis, "slant" the news. 42 -i tends to 4. People seeking public support for almost any issue tend to think of the news media as natural resources for exploitation. And reporters who specialize in science and environmental reporting face three additional problems: open conflict with other groups, resentative often engages in attacking an adversary suspecting vehicles for use in Burrows (8) or deflect- concludes that such relationships can have important consequences tainly, and un- oi at least news reporters may be considered potential allies Ing an attack. industry, Each group or group rep- groups. and so-called public interest government, for politics in these four basic problems and scciety. Cer- news reporting have had an impact on the Agent Orange controversy. Inadequate Government Response The March 1978 television documentary precipitated numerous inquiries with the Veterans Administration the country. in all areas of The symptoms were the same as tiPe symptoms report- ed by the veterans in the documentary: constant fatigue, toes, (VA) weight loss, numbness in birth defects, fingers and and cancer. health problems stemmed from ex- All claimants stated that their posure to Agent Orange and thus marked the begAinning of the problem. When veterans to their experience health problems nresumably related military tours of duty, for medical care, they can report to VA hospitals and they can file 4j3 claims for a disability that may be associated with their pital officials past military service. advise them that evidence of the earliest Hosmani- festation of symptoms and continuing symptoms must accompany claims for specific disabilities. Orange, For cases involving Agent VA policies are outlined in "Rating Practices and Pro- cedures Disability - Vietnam Defoliant Exposure," a document used to process claims alleging a relationship between defoliant exposure and disability. procedure, But, in filing claims under this veterans can claim damage only for chloracne because the Veterans Administration recognizes no other symptoms or conditions as causes of health problems based on exposure to herbicides. Congress has not deemed it to recognize any disability related to Agent Orange as a chronic constitutional disability (e.g., Title ic multiple sclerosis). 38 USC makes no provisions for claims alleging genet- damage to offspring as a result bicides. If veterans than disability istration all the Veterans Admin- disallows the claims and advises the veterans that not a disease or disability. They must claim but there are no special procedures for these claims. available evidence, Each case depends on accumulation of including a request to the veteran and his service department for verification cides, exposure to her- claim only exposure to a herbicide rather specific disabilities, initiating of veterans' resulting from the exposure, mere exposure is 74 appropriate of exposure to herbi- the extent and duration of the exposure, and the dates of the exposures. Thus, one Is not surprised that many veterans consider the Veterans Administration unresponsive to their lems. On the other hand, health prob- the administrator of the Veterans Administration offered these comments during a recent congressional inquiry: ... everyone wants to know immediately the definitive answers to the questions posed Unfortunately, the scienby Agent Orange. tific inquiry process necessary to provide accurate reliable information does not alto immediate answers... ways lend itself In the meantime, we shall continue to provide every eligible veteran we examine, and find to be in need of treatment, appropriate care regardless of causation. (9) We owe them no less. Special Interest Groups Numerous special interest groups represent and assist Vietnam veterans with problems related to Agent Grange. groups include the National Veterarin Agent Orange Victims International, ties Citizen Soldier, and Viet- are the activi- of the National Veterans Law Center and the Veterans Edu- cation Project, ties Task Force on Agent Orange, Especially notewcrthy nam Veterans of America. These a program sponsored by the American Civil Liber- Union Foundation. "Agent Orange Packet" These two groups have prepared an (36) consisting of guidelines claims with the Veterans Administration. 45 for filing Both groups encourage veterans to file claims if they have medical problems that might be caused by Agent Orange. Nothing will guarantee that the VA will As a matter give you the help you need. of fact, through December 1979, the VA those claims where had turned down all problems were caused veterans said their But there are two good by Agent Orange. reasons you should go ahead and immediat the VA. ately Tet your claim on file if your claim is granted, your First, benefits will go back to the date you Even if your claim your claim. filed changes is turned down, but the VA later about Agent Orange, they attitude its and be able will have your claim on file to reopen it quickly. Second, taking the time to go the VA shows how serious you are about this problem and that you think the government has a responsibility to help. The government can be impressed with a large number of vets requesting help can make a difference. (36) statistics Special interest groups representing veterans of the Viet- nam era apply tremendous pressure on government officials agencies to resolve the Agent Orange issue. the House Committee on Veterans' Robert Muller (25) Affairs in and At a hearing before February 1980, concluded his testimony on Agent Orange with these statements: The exposure of Vietnam veterans to Agent Orange may have created the largest environmental crises of the chemical age. Compensating victims will, accordingly, stretch the very fabric of our remedial structure. 46 But while the oroblem is new, and tt:• scope huge, Agent Orange is only t,ý< first of what may be several maijor compensation policy questions sterir..g from exposure to toxic chemicals !olre Canal) or radiation (Three M1ie IP r,.-id Fz For environmental law in Armerta hm-,4 been oriented toward the prevention ,f disasters, not compensation foi* disasters. Its dream has been triat ti:e problems of compensation could be preempted by precluding wide-scale ernvironmental catasrophies. That dream been disproved. 14 Agent Orange policy is important n,: just because of the thousanrds of liv. at stake, but because it brings pensation problem to a head. In t,.•> f'inal analysis, as it sets a compensat icy for Vietnam veterans, the governmre:,ý is also establishing the precedent f-Q c •mpensation policy generally. Initiation of Lawsuits As noted by Muller, Agent Crangre has i 4ee, ->beer. the basis of legal action and immense claims for a class action suit New York in amounting to 40 1079 on behalf "of all b-7 generation but during those wenerct',on.r makers of Agent orange _ (.o. tnn- have been and now to be situated at rrs., toxic effects of dioxin (27). For example, This .. was filed r•unat• ;, -_ vet c'uring this ,oe" from the aw• ed the (six chemical konpaniec) ,t nrove the safety of products contnminated with. L].5g.Ition, i:c! lawsuit asks the companies to establIsh a tK-,'xeiat fund sufficient (i.e., to cover taamages cantsec to reimiurse the Veterans 47 as to - .: the reserve :, c!des -neflts in and compensate victims and their families). The suit also specifies that the costs of the actions should not be passed to customers of utility companies that used herbicides in maintain- Ing rights-of-way. In another recent legal action, the US District Court for Eastern Arkansas ruled that any amount of dioxin in of water from wastes stored by a manufacturer had no proof of actual harm, of 2,4,5-T. It concluded that risk Al- the court considered the probabilities of any harm and the possible consequences harm. too The court was concerned with potential contamination much (1). though it water is of such to the public Justified an Injunc- tion requiring reasonable abatement of the health hazard as a precautionary and preventive measure. Certainly, a ruling thet there is no safe level of exposure to TCDD may influence other court cases involving veterans and Agent Orange. of cause and effect is placed before When the issue juries of lay citizens, emo- tion over the plight of veterans can "win the day" over scientific verity. Advisory Groups The position taken by the media, groups, ''.e various special interest and the courts has obviously drawn national attention to plight c_-Q•tz• . Indeed, thr Agent Orange contra- iersy has been the focus -f much congressioral Octobe;. 1978. Subcommittees interest since for both Senate and House of ................. A. Representatives mony on the subject four times during the p resentatives tions, hleard testi- Affitrs nave Committees on Veterans' two years. of numerous government agencies, Rep- institu- academic groups offered t-,eir ideas on ways and sDecial interest to resolve the issue. In April 1979, established a the Veterans Administraton of most of the member advisory committee "representative fifteen varied public and private sector elements cide controversy" The task of the comnirttee is (9). the herbi- involved in to assemble and analyze information needed by the Veterans Admlnistration to in formulate appropriate medical policy and pzc_,.dures of involved veterans. rest It held the inte- oo~n meetings during six 1979 and 1980 and offered the following slgrA.nfcant recommendations: 1. Conduct an epidemiological stu;r,'- Soc .nd In U.S. Government Prir•rt pD. 4-40. 59 7- r. Morb. t' 10. Committee on the Effects of Herbicides In South Vietnam. 1974. The effects of herbicides in South Vietnam. Part National Academy of Science, A. Summary and. Conclusions. Washington DC. 398 pp. 11. Cook, R.R., J.C. Townsend, M.G. Ott, and L.G. Silverstein. 1980. Mortality experience of employees exJ. Occup. posed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Med. 22(8):530-532. 12. Council for 1979. A plague on our children. CAST. Agricultural Science and Technology, Report No. 81. Department of Agronomy, 17 P. Headquarters Office: 50010. Iowa State University, Ames I0. 13. The poison that won't go Culhane, J. 1980. PCBs: Reader's Digest 117(704):112-116. away. 14. Cutting, R.T., T.H. Phuoc, J.M. Ballo, M.W. Benenson, Congential malformations, 1970. and C.H. Evans. in the Republic of hydatidiform moles and stillbirths Document No. 903.233. Vietnam, 1960-1969. Government Printing Office, Washington DC. 1974. DDT: A renaissance? 8(4):322-325. U.S. 29 pp. Environ. 15. Devlin, R.M. Scl. Technol. 16. Selected 1977. Diaz-Colon, J.D., and R.W. Bovey. III. bibliography of the phenoxy herbicides. Bulletin MP-1343, Toxicological studies in animals. Texas Agricultural Experiment Station, Texas A & M University, College Station TX. 105 p. 17. Uncertain science pushes Love 1980. Ember, L.R. Chem. Canal solutions to political, legal arenas. News 58(32):22-29. Eng. 18. U.S. ground troops in South Vietnam were 1979. GAO. Report by in areas sprayed with Herbicide Orange. the Comptroller General of the United States. General Accounting Office, Washington DC. 12 pp. 19. PolyChemical pollution: 1972. Hammond, A.L. chlorinated biphenyls. Science 1?5:156-157. 20. Kociba, R.J., D.G. Keyes, J.E. Beyer, R.M. Carreon, C.E. Wade, D.A. Dittenber, R.P. Kalnins, L.E. Frauson. C.N. Park, S.D. Barnard, R.A. Hummel, and C.G. Humiston. Results of a two-year chronic toxicity and onco1978. genicity study of 2,3,7,8-tetrachlorodibenzo-p-dioxin 46:270-303. Appl. Pharmacol. in rats. Toxicol. 60 I 21. Kociba, R.J., D.G. Keyes, h.W. LIE-,ewe,. D.D. Dittenber, C.E. Wade, S.J. Grr and B.A. Schwetz. 1979. Result,; of . .he, cronic ':-e toxicity and oncogenic study of rat,' co-taininc- 2,4,5-trichlorophencx'raceP.C, Food Cosmet. Toxiccl. 17:205-221. e7s ( 22. Kurtis, B. 1978. "Agent cranre V,:r.... : ,i'v Fog". Transcript of a televtslon docui:.e:tary a{red 12 March 1978, WBBM-TV, Chicago I.. -iCi;p. 23. Lamb, J.C. , J.A. Moore, and T.A. Mark•-.. 9ý rvaluation of 2,4-dichlorophenoxyacet.c ac .5- ': 8 r, trichiorophenoxyacetic acid (2,4,)-T), tetrachiorodi.benzo-p-dioxin (TCD-D) -x....-.. in•.rB/, mice: Renroduction and. fertilitv in mice and evaluation of congenital malform < toffspring. National Toxicologyý,- ro. . -" 44. National- Toxicology Program, He ' .. -_ ark, NC 27709. 56 pp. I 24. Meselson, M.S., A.H. Westing, and J Background material relevant to nrez--e. " 1970 annual meeting of the Jiý&S coHezn. t Assessment Commission for the er:. , the Advancement of Science. Ar eic the Advancement of Science, Wahi o......" 25. Muller, R.O. 1980. PreparrK Staterie_ Muller, Executive Director, Vietna-n T7ee, Oversight Hearing to Receive ..... ...... Hearing Before the Subcommittee on ,' and Benefits of the Committee Ve7,. House of Representatives, ,ine-T¢y-stx .i Second Session. February 25, 1930. U.•'. S. Printing Office, Washington 9x2. p. 26. 27. 28. 29. Neel, S. 1973. Medical Vietnam 1965-1970. Vietnam 3t-ldies' Army, Washtngton DC. 19r; 00. Payne, K.J. 1979. Beyond Vie-n.un, beyond causes. Barrister (Snring):l-3 Rose, H.A. and S.P.R. Rose. 1072. as reported by refugees from I-outn Vi 177:710-712. 1971. , tne *'erbicide for for erica. >les Ie vh-rn2ent In ' ,, of the . 32. ., 1. -.. . .... .. . -- -- .---. 'i-- -...- - nce '. Svri, M.A. 1979. Summary -f e-cr, istics of herbloide-related lair : : Veterans Administration as of 3T Ao2W L4 '-] Report. Enidemiology Division, iA? .' l Mediine, Brooks AFB TX. 4 'P. 61 . .....' •_• . . C. ot , ,-& r J-> .bl. %-.rospace - _ _. . 30. Schwetz, B.A., J.M. Norris, G.L. Sparshu, V.K. Rowe, 1973. P.J. Gehring, J.L. Emerson, and C.G. Gerbig. Toxicology of the chlorinated dibenzo-p-dioxins. 5:37-99. Environ. Health Perspect. 31. Shapley, 32. Smith, F.A., B.A. Schwetz, F.J. Murray, A.A. Crawford, 1978. J.A. John, R.J. Kociba, ard C.G. Humiston. rats ingesting in study reproductive Three-generation Toxi2,4,5-trichlorophenoxyacetic acid in the diet. 45:293. col. Appl. Pharmacol. 33. Scientific Dispute 1979. Tschlrley, F.H. (Ed.). Sponsored by the Resolution Conference on 2,4,5-T. Nu Vue Printing, American Faim Bureau Federation. 101 pp. Richmond IL 60071. 34. Tung, T.T., T.K. Anh, B.Q. Tuyen, D.X. Tra, and N.X. Clinical effects of massive and contin1971. Hugen. Vietof defoliants on civilians. uous utilization namese Studies 29:53-81. 35. Tung, T.T., T.T. An, N.D. Tam, T.T. Bach, H. VanSon, and D.K. primaire du fole au Viet-Nam. 36. Agent Orange Packet. 1980. Veterans Education Project. National Veterans Information Clearinghouse on Agent Room 904, 1346 Connecticut Avenue NW, Orange. 31 pp. Washington DC 20036. 37. Wade, N. p. VIII. 38. "Agent Orange in Perspective". 1980. Wolfe, W.H. Presentation to the Inland Agricultural Chemical Avail10 December 1980. Spokane WA. Association. able from Epidemiology Division, USAF School of Aero6 pp. space Medicine, Brooks AFB TX 78235. 39. Report of the Advisory 1971. (Chairman). Wilson, J.G. of the EnvironAdministrator Committee on 2,4,5-T to the 7 May 1971. submitted Report mental Protection Agency. U.S. Environmental Protection Agency, Washington DC. D. 1974. 1980. Score one for Dow. Mythopolesis. 75 pp. 62 J Science 185:509. P.H. Phiet, N.N. Bang, Le cancer 1973. Son. Chirurgie 99(7):427-436. Protest TIBS, June 1980, 40. Use of herbicides in South Vietnam. 1980. Young, A.L. Proceedings, Veterans Administration Educ1961-1971. ational Conference on Herbicide Orange, Silver Springs Veterans Administration, Washington MD, 28 May 1980. 17 pp. DC. 41. Young, A.L., J.A. Calcagni, C.E. Thalken, and J.W. The toxicology, environmental fate, 1978. Tremblay. and human risk of Herbicide Orange and its associated USAF OccuTechnical Report OEHL-TR-78-92. dioxin. pational and Environmental Health Laboratory, Brooks 247 pp. APB TX 78235. 42. The mortality 1980. Zack, J.A. and R.R. Suskind. tetrachlorodibenozoto exposed workers of experience J. dioxin in a trichlorophenol process accident. 22(l):11-14. Occup. Med. j 63