| What you haven't been told |
As Published in the International Journal of Health
Services, Volume 28, Number 4, Pages 715 to 724,
1998
Orebro Medical Center, Hospital
Department of General Oncology.
Lennart Hardell
M.D., Ph.D., Associate Professor
Phone +46 19.15 15 46
Fax +46 19-18 35 10
Private +46 19.32 36 40
Department of General oncology,
Orebro Medical center Hospital,
5.701 85 Orebro, Orebro county council, Sweden,
Tel vx +46 19-15 10 00
Home address: Vadarvagen 4, S-702 20 Orebro
Sweden
Environmental Policy
Services, Volume 28, Number 4, Pages 715 to 724,
1998
Orebro Medical Center, Hospital
Department of General Oncology.
Lennart Hardell
M.D., Ph.D., Associate Professor
Phone +46 19.15 15 46
Fax +46 19-18 35 10
Private +46 19.32 36 40
Department of General oncology,
Orebro Medical center Hospital,
5.701 85 Orebro, Orebro county council, Sweden,
Tel vx +46 19-15 10 00
Home address: Vadarvagen 4, S-702 20 Orebro
Sweden
Environmental Policy
AGENT ORANGE IN WAR MEDICINE: AN AFTERMATH MYTH
Lennart Hardell, Mikael Eriksson, and Olav Axelson
Since the late 1970s several epidemiological studies have appeared on exposure
to phenoxy herbicides or chlorophenols and some malignant tumors. Most of
these compounds are contaminated with dioxins and dibenzofurans; for
example, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is a contaminant of
2,4,5-trichlorophenoxyacetic acid (2,4,5.T), a component of Agent Orange
which was sprayed in Vietnam during the war. The results of some of the
epidemiological studies on cancer risks associated with exposure to these
compounds have been manipulated and misinterpreted, particularly' by the
Australian Royal Commission on the Use and Effects of Chemical Agents on
Australian Personnel in Vietnam. Furthermore, a bock on Australian war history
entitled Medicine at War, commissioned by the Federal Government, reiterates
several of these misinterpretations, despite available contrary evaluations from
Australian and U.S. authorities. These remarkable and contusing circumstances
in the scientific process are considered also in the light of the recent classification
of TCDD as carcinogenic to humans, Group 1, by a Working Group at the
International Agency for Resear0h on Cancer in Lyon, France.
Several epidemiological studies have appeared since the late 1970s linking
exposure to phenoxyacetic acids (i.e., herbicides in Agent Orange) or
chlorophenols to some malignant tumors. The results of these and other studies
on this topic have been scrutinized by different organisations and committees
such as the Australian Royal Commission on the Use and Effects of Chemical
Agents on Australian Personnel in Vietnam. The aim of this Commission was to
evaluate the scientific evidence for potential health effects on Australian soldiers
exposed to Agent Orange in the Vietnam War. The Royal Commission’s
conclusions that there were no health risks due to exposure to Agent Orange
have been both disputed and echoed by different authors. The statements by the
Royal Commission are quite contrary to the recent conclusion by a Working
Group at the International Agency for Research on Cancer (IARC) in Lyon,
France. In its overall evaluation, the IARC group concluded that 2,3,7,8-
tetrachlorodibenzo-p-dioxin (TCCD), a contaminant of Agent Orange, is a
Group 1 carcinogen in humans (1). The group noted that the epidemiological
data contributed strong evidence of increased risk for all cancers combined, but
with highest risk estimates for non-Hodgkin's lymphoma and soft-tissue sarcoma.
In the light of this evaluation, we must discuss here a book entitled Medicine at
War, funded in part by the Australian Government and edited and written by
two Australian professors of history, Brendan O'Keefe and F. B. Smith (2). It
claims to give the true picture of the medical aspects of the use of Agent Orange
in the Vietnam War. Professor Smith wrote Part IV, "Agent Orange: The
Australian Aftermath." The book does not reflect the circumstances surrounding
the use of Agent Orange, however, or the controversy following the report by
the Australian Royal Commission on the Use and Effects of Chemical Agents on
Australian Personnel in Vietnam (3). Instead, the book seems to be an apologia
on behalf of the Royal Commission and its Commissioner, Justice Phillip Evatt,
who disregarded the epidemiological evidence on the carcinogenic effects of
phenoxy herbicides and concluded that exposure to Agent Orange is harmless
as far as malignant diseases are concerned.
This standpoint is hardly "historical"; it does not reflect the debate that followed
the Commission's report or the recent evaluation by IARC (1). Furthermore,
Smith and O'Keefe ignored an expert review commissioned by the Australian
Minister for Veterans' Affairs (4), which concluded that there is sufficient
scientific evidence to support an association between exposure to phenoxy
herbicides and development of certain diseases, among them several
malignancies. This document was in part based on a report by the National
Academy of Sciences, Institute of Medicine, in Washington, D.C. (5).
Given the above background, it seems necessary to describe the "historical
truth" from another perspective, so as to provide historians with some
reasonably detailed information on what has actually occurred. Furthermore, this
story might be illustrative of how economic and possibly other interests tend to
undermine efforts in public health to eliminate hazardous exposures, in this case
the phenoxy herbicides constituting Agent Orange.
Lennart Hardell, Mikael Eriksson, and Olav Axelson
Since the late 1970s several epidemiological studies have appeared on exposure
to phenoxy herbicides or chlorophenols and some malignant tumors. Most of
these compounds are contaminated with dioxins and dibenzofurans; for
example, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is a contaminant of
2,4,5-trichlorophenoxyacetic acid (2,4,5.T), a component of Agent Orange
which was sprayed in Vietnam during the war. The results of some of the
epidemiological studies on cancer risks associated with exposure to these
compounds have been manipulated and misinterpreted, particularly' by the
Australian Royal Commission on the Use and Effects of Chemical Agents on
Australian Personnel in Vietnam. Furthermore, a bock on Australian war history
entitled Medicine at War, commissioned by the Federal Government, reiterates
several of these misinterpretations, despite available contrary evaluations from
Australian and U.S. authorities. These remarkable and contusing circumstances
in the scientific process are considered also in the light of the recent classification
of TCDD as carcinogenic to humans, Group 1, by a Working Group at the
International Agency for Resear0h on Cancer in Lyon, France.
Several epidemiological studies have appeared since the late 1970s linking
exposure to phenoxyacetic acids (i.e., herbicides in Agent Orange) or
chlorophenols to some malignant tumors. The results of these and other studies
on this topic have been scrutinized by different organisations and committees
such as the Australian Royal Commission on the Use and Effects of Chemical
Agents on Australian Personnel in Vietnam. The aim of this Commission was to
evaluate the scientific evidence for potential health effects on Australian soldiers
exposed to Agent Orange in the Vietnam War. The Royal Commission’s
conclusions that there were no health risks due to exposure to Agent Orange
have been both disputed and echoed by different authors. The statements by the
Royal Commission are quite contrary to the recent conclusion by a Working
Group at the International Agency for Research on Cancer (IARC) in Lyon,
France. In its overall evaluation, the IARC group concluded that 2,3,7,8-
tetrachlorodibenzo-p-dioxin (TCCD), a contaminant of Agent Orange, is a
Group 1 carcinogen in humans (1). The group noted that the epidemiological
data contributed strong evidence of increased risk for all cancers combined, but
with highest risk estimates for non-Hodgkin's lymphoma and soft-tissue sarcoma.
In the light of this evaluation, we must discuss here a book entitled Medicine at
War, funded in part by the Australian Government and edited and written by
two Australian professors of history, Brendan O'Keefe and F. B. Smith (2). It
claims to give the true picture of the medical aspects of the use of Agent Orange
in the Vietnam War. Professor Smith wrote Part IV, "Agent Orange: The
Australian Aftermath." The book does not reflect the circumstances surrounding
the use of Agent Orange, however, or the controversy following the report by
the Australian Royal Commission on the Use and Effects of Chemical Agents on
Australian Personnel in Vietnam (3). Instead, the book seems to be an apologia
on behalf of the Royal Commission and its Commissioner, Justice Phillip Evatt,
who disregarded the epidemiological evidence on the carcinogenic effects of
phenoxy herbicides and concluded that exposure to Agent Orange is harmless
as far as malignant diseases are concerned.
This standpoint is hardly "historical"; it does not reflect the debate that followed
the Commission's report or the recent evaluation by IARC (1). Furthermore,
Smith and O'Keefe ignored an expert review commissioned by the Australian
Minister for Veterans' Affairs (4), which concluded that there is sufficient
scientific evidence to support an association between exposure to phenoxy
herbicides and development of certain diseases, among them several
malignancies. This document was in part based on a report by the National
Academy of Sciences, Institute of Medicine, in Washington, D.C. (5).
Given the above background, it seems necessary to describe the "historical
truth" from another perspective, so as to provide historians with some
reasonably detailed information on what has actually occurred. Furthermore, this
story might be illustrative of how economic and possibly other interests tend to
undermine efforts in public health to eliminate hazardous exposures, in this case
the phenoxy herbicides constituting Agent Orange.