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Assessing Health Outcomes Among Veterans of Project SHAD (Shipboard Hazard and Defense)

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Assessing Health Outcomes Among Veterans of Project SHAD (Shipboard Hazard and Defense) Assessing Health Outcomes Among Veterans of Project SHAD (Shipboard Hazard and Defense) Committee on Shipboard Hazard and Defense II (SHAD II) Board on the Health of Select Populations Institute of Medicine Copyright © National Academy of Sciences. All rights reserved. Assessing Health Outcomes Among Veterans of Project SHAD (Shipboard Hazard and Defense) THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by Task Order No. 2 under Contract No. VA241-P-2024 from the Department of Veterans Affairs, with additional support from the National Academy of Sciences and the National Academy of Medicine. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-38071-3 International Standard Book Number-10: 0-309-38071-5 Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2016 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Assessing health outcomes among veterans of Project SHAD (Shipboard Hazard and Defense). Washington, DC: The National Academies Press. Copyright © National Academy of Sciences. All rights reserved. Assessing Health Outcomes Among Veterans of Project SHAD (Shipboard Hazard and Defense) The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org. Copyright © National Academy of Sciences. All rights reserved. Assessing Health Outcomes Among Veterans of Project SHAD (Shipboard Hazard and Defense) Copyright © National Academy of Sciences. All rights reserved. Assessing Health Outcomes Among Veterans of Project SHAD (Shipboard Hazard and Defense) COMMITTEE ON SHIPBOARD HAZARD AND DEFENSE II (SHAD II) DAVID J. TOLLERUD (Chair), Professor and Chair, Department of Environmental and Occupational Health Sciences, University of Louisville School of Public Health and Information Sciences JOSEPH A. BOSCARINO, Senior Scientist, Center for Health Research, Geisinger Clinic, Danville, Pennsylvania LINDA A. MCCAULEY, Professor and Dean, Nell Hodgson Woodruff School of Nursing, Emory University THOMAS E. MCKONE, Senior Staff Scientist and Deputy Division Director, Lawrence Berkeley National Laboratory KENNETH R. STILL, Scientific Director and Senior Toxicology and Industrial Hygiene Consultant, Occupational Toxicology Associates, Inc., Lake Oswego, Oregon, and Adjunct Assistant Professor, Portland State University, School of Community Health, College of Urban and Public Affairs, Portland, Oregon BETH A. VIRNIG, Professor and Senior Associate Dean for Academic Affairs and Research, University of Minnesota School of Public Health YILIANG ZHU, Professor, Department of Epidemiology and Biostatistics, College of Public Health, and Professor, Internal Medicine, Morsani College of Medicine, University of South Florida Consultants DANIEL H. FREEMAN, JR., Professor Emeritus of Preventive Medicine and Community Health, University of Texas Medical Branch at Galveston CYNTHIA C. JOHNSON, Nosologist, Richmond, Virginia ALFRED K. MBAH, Assistant Professor of Biostatistics and Epidemiology, University of South Florida JAMES E. QUINN, Commander, U.S. Navy, Retired IOM Staff LOIS JOELLENBECK, Study Director HARRIET CRAWFORD, IT Project Manager REINE HOMAWOO, Programmer/Analyst DWAYNE BELL, Programmer/Analyst (through June 2015) HEATHER YOUNG, Biostatistician (through November 2014) JANE DURCH, Senior Program Officer JON SANDERS, Program Associate (through January 2015) ASHLEY MAYO, Intern (Summer 2012, 2013) JULIE WILTSHIRE, Financial Associate FREDERICK ERDTMANN, Director, Board on the Health of Select Populations v Copyright © National Academy of Sciences. All rights reserved. Assessing Health Outcomes Among Veterans of Project SHAD (Shipboard Hazard and Defense) Copyright © National Academy of Sciences. All rights reserved. Assessing Health Outcomes Among Veterans of Project SHAD (Shipboard Hazard and Defense) Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: David B. Allison, University of Alabama at Birmingham Joel Greenhouse, Carnegie Mellon University David G. Hoel, Exponent Howard M. Kipen, Rutgers School of Public Health Kenneth W. Kizer, University of California, Davis, School of Medicine and Betty Irene Moore School of Nursing Nan M. Laird, School of Public Health, Harvard University Raphael C. Lee, The University of Chicago David A. Macys, Oak Harbor, Washington Robert B. Wallace, University of Iowa College of Public Health Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Stephen E. Fienberg, Carnegie Mellon University, and George W. Rutherford, University of California, San Francisco. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. vii Copyright © National Academy of Sciences. All rights reserved. Assessing Health Outcomes Among Veterans of Project SHAD (Shipboard Hazard and Defense) Copyright © National Academy of Sciences. All rights reserved. Assessing Health Outcomes Among Veterans of Project SHAD (Shipboard Hazard and Defense) Preface When the secret Project Shipboard Hazard and Defense (SHAD) testing program was made public in 2000, veterans reasonably wondered what impact their involvement in the testing might have had on their health. Following the release of the first Institute of Medicine (IOM) SHAD report in 2007, Congress requested that the IOM undertake a new epidemiological study of the potential long-term health effects of participation in the SHAD testing. Our committee, with expertise in epidemiology, occupational health, biostatistics, exposure assessment, toxicology, and Vietnam veterans’ health issues, was convened to examine this question, a role the committee took very seriously. Our careful review of published scientific literature on the agents, simulants, tracers, and decontaminants used in the tests, led us to formulate hypotheses on health effects that might be associated with exposure to six of these substances. We also undertook exploratory analyses to ensure that unanticipated associations would not be overlooked. Our task was challenging because of the passage of time since the tests, and because many of the documents related to the tests remain classified. Our requests for declassification of additional documents were not approved. Using the limited information available in redacted reports on these tests, the committee evaluated exposure opportunities that test participants may have had. The study faced other challenges as well. Protecting the security of the data used in the study was, of course, of high importance to the committee and to the Department of Veterans Affairs (VA). Meeting those obligations made it necessary to work within the VA information technology system, and this posed a series of requirements that significantly
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