The Political Science of Agent Orange
Michael Gough (excerpts by NMQ)
Michael Gough is an
Adjunct Scholar at The Cato Institute. He presented this paper at the MIT
Security Studies Program Conference on “Acceptable Weapons”
Jungles
and forests have always presented problems for armies operating in areas that
are contested by hit-and-run or guerrilla forces. If you have the chance to see
the movie The Devil’s Disciple on an old movie channel, it graphically
depicts the success of the American Colonials in slowing the progress of
General “Gentleman Johnny” Burgoyne’s British Army through the New England
forests during the Revolutionary War. Almost two centuries later, the shoe was
on the other foot when
Military scientists
who worked on those projects as well as scientists working to develop weed-killers
for the civilian market were successful, and chemical defoliants and herbicides
were liberally applied to post World War Two farms and forests, golf courses,
suburban lawns, and railroad, utility, and highway rights of way. Many of those
same chemicals were used during the Vietnam War.
Between 1961 and 1970,
the United States military sprayed the herbicide Agent Orange, a mixture of two
widely used agricultural chemicals, over the enemy-controlled jungles (now
called "rain forests") and crop-growing regions of South Vietnam.1 Agent Orange was shipped to Vietnam in 55-gallon drums circled by a
stripe of orange paint for easy sorting from other herbicides – Agents White,
Blue, and Purple, etc. While under development in the mid-1940s, one of the
chemicals in Agent Orange – 2,4-dichlorophenoxyacetic
acid or 2,4-D – was used to kill dandelions in front of the Smithsonian on the
National Mall. It continues in worldwide use as an effective herbicide against
broadleaf weeds, and it’s available in every hardware and most grocery stores in
Weed-Be-Gone and other popular products.
The other Agent Orange
component – 2,4,5-trichlorophenoxyacetice acid or
2,4,5-T – was removed from markets around the world, after about 30 years of
use, in the late 1970s and 80s because of concerns that dioxin, specifically
2,3,7,8-tetrachlorodibenzo-para-dioxin or 2,3,7,8-TCDD or TCDD, an unavoidable
contaminant of the manufacture of 2,4,5-T, was a cause of cancer and other diseases.2
In fact, the risks
from dioxin were overstated. In 2001, the Environmental Protection Agency’s
Science Advisory Board concluded that EPA has been unable to show that dioxin
is acause of human cancer and other diseases.3 Furthermore, studies of workers exposed to much higher levels of dioxin
than experienced by any Vietnam veteran have failed to produce any conclusive
evidence of connections between dioxin and cancer4 and the other
health effects 5 claimed by veterans.
The United States
stopped using Agent Orange in
By
1975, veterans, supported by some scientists and politicians, were demanding
medical treatment and monetary compensation for their own diseases and for
birth defects in their children that they blamed on Agent Orange. Their efforts
received a huge boost from two television programs that associated Agent Orange
with cancer in veterans and birth defects in their children.6
The programs found
audiences ready to believe that Agent Orange caused diseases. For one thing,
the United States public, long ago disenchanted with the Vietnam War and, by
the late 1970s, immersed in guilt about its treatment of Vietnam veterans,
willingly accepted the idea that a chemical – Agent Orange – was at the root of
veterans' complaints. Moreover, environmental chemicals as the cause of human
disease were staples of nightly newscasts, magazine and newspaper articles,
environmental organizations' fund raising and public relations campaigns,
lawyers looking for companies to sue, and government officials eager to
increase the reach of their agencies by expanding the fight against
disease-causing environmental pollution. Agent Orange and dioxin became the
ugly poster children for nasty environmental chemicals.
Through 1978, the
Veterans Administration (VA) rebuffed veterans’ claims for treatment and
compensation for “Agent Orange diseases,” saying that there was no evidence for
a link between Agent Orange and the diseases for which claims were made. The
veterans then took their claims to Congress.5
Congress
could have responded to veterans’ claims by directing the VA to provide medical
care and to pay compensation to the veterans, in the absence of any evidence
about causation, basing its decision on compassion or other policy
considerations. It did not do that. In retrospect, if it had, it would have
been a cleaner political decision as compared to the legislative obscurity and
bad scientific decisions that followed.
The clamor for
providing treatment for Agent Orange-related diseases decreased in the 1980s
when the VA, with increased funding for its hospitals (Public Law 97-72,
enacted in November 1981) provided treatment for “Agent Orange-related
diseases.” Importantly, the veteran did not have to prove exposure to Agent
Orange to qualify for treatment. Instead, Congress presumed that exposure to
Agent Orange caused the veteran’s illness unless a congenital condition or some
other exposure was shown to be a more likely cause.7 In practice, the law makes
any disease in
In 1979, Congress
(Public Law 96-151) ordered VA to plan and carry out a study of the health of
Agent Orange-exposed veterans.8 VA failed to get the study
underway in a timely manner (in fairness to VA, such a study had never been
done, and it was far beyond the expertise and experience of VA staff). The
Centers for Disease Control (the agency is now the Centers for Disease Control
and Prevention, but I’ll use the old name and abbreviation “CDC,” a part of the
Department of Health and Human Services, DHHS)
maneuvered itself into being made responsible for the study in 1982.6
CDC’s “
In 1982, because there
was no way to determine whether an individual had been exposed to Agent Orange,
CDC decided to compare the health of Vietnam veterans with the health of
veterans whohad not served in Vietnam in the
"Vietnam experience studies."9 A quick
summary of this research is to say that the CDC found nothing to link
Many people, who had
looked for the Vietnam Experience Studies to verify that the war
was causing health problems, were disappointed. In
particular, and with justification, they said that the effects of Agent Orange
might have been overlooked because there was no way to identify veterans who
had been exposed to it.
CDC’s Measurements of Agent Orange Exposure.
After it enters the
body by absorption through the skin, inhalation, or ingestion, dioxin, the
chemical contaminant in Agent Orange, is deposited in the lipid (or fat) of the
human body. It is very stable and only very slowly eliminated from lipid so
that measuring dioxin concentrations in lipid today can provide information
about exposures that happened decades ago. In the mid-1980s, CDC imported more
sensitive methods and instruments from
In its Agent Orange
exposure study, the CDC identified 600 Vietnam veterans who had been present at
times and in areas near where the Air Force’s Operation Ranch Hand had sprayed
Agent Orange and compared the concentrations of dioxin in the blood lipids
(these concentrations are called “body burdens”) of those veterans to the
concentrations in some 100 other veterans who 7 had never served in Vietnam. The dioxin concentrations in the
"exposed" and non-exposed veterans were the same, and the
concentrations in both groups fell within the background concentrations
measured in the general population.10
These results were no
surprise to experts in pesticide application and dispersal, who had argued all along
that the concentrations of Agent Orange reaching the ground where troops might
be exposed were insignificant.11 Some veterans and some members
of Congress dismissed these results, as they had dismissed the results of the
Vietnam Experience studies, as incompetently done or, worse, as “cover-ups.”
In
2005, the Air Force will complete its 20-year-long study of the health of the
1,200 Ranch Hands, the Air Force personnel who sprayed 90 percent of the Agent
Orange used in Vietnam, and a Comparison group of Air Force personnel who flew
similar planes to the C-123s flown by Ranch Hands in Southeast Asia but did not
handle herbicides. Measurements of dioxin levels confirm that many of the Ranch
Hands were exposed to Agent Orange.
The Ranch Hands and
Comparisons have undergone week-long physical and psychological examinations at
5-year intervals beginning in 1982. The examinations are carried out in
civilian hospitals by physicians and technicians who are not told which men are
in the Ranch Hand and which are in the Comparison group. The Air Force has
published the results from the first four examinations (done in 1982, 1987,
1992, and 1997), and the final results will be published as data is collected
and analyzed from the 2002 examination.
The Air Force
scientists who direct the Ranch Hand study have concluded that dioxin exposure
is associated with increased risk of adult-onset diabetes because diabetes is
more common 8
in the Ranch Hands with higher dioxin levels.12 I disagree with that conclusion because the incidence of diabetes is the
same in the Ranch Hands and the Comparisons, which is not consistent with an
association between exposure and risk.
In their most recent
comment on the possible dioxin - diabetes link, the Air Force scientists state
that the glimmers of evidence that there was a connection from data collected
in the 1992 physical exams of the Ranch Hands and Comparisons “were weaker” in
the 1997 exams.13 I doubt that anyone besides the Air Force investigators, who are under
enormous political pressure “to find something” that is associated with Agent
Orange, an Institute of Medicine (IOM) committee , and some champions of
Vietnam veterans’ health claims would interpret the available data to indicate
that any connection exists.
To its great credit,
the Air Force has made all its records and analyses – suitably stripped of
personal identifiers – available to anyone who requests them. 14 The Air Force study’s web page, http://www.brooks.af.mil/AFRL/HED/hedb/afhs/afhs.html,
provides citations to all the Air Force study publications and the text of some
of the publications. It also provides information about obtaining data from the
studies.
As
study results rolled in and the terrible things believed to result from Agent
Orange exposure weren’t seen, politics played a bigger role. During the late
1980s, VA established its Advisory Committee on Environmental Hazards15 and appointed as chairman, retired Admiral Elmo Zumwalt,
a fierce partisan in the Agent Orange controversy, who blamed his son’s cancer
and his grandson’s neurological condition on the son’s exposure to Agent Orange
in Vietnam.
Responding to an
analysis of possible links between Agent Orange and diseases sponsored by the
American Legion, the Vietnam Veterans of America, and the National Veterans
Legal Services Project,16 Zumwalt’s
committee concluded that a linkage existed between Agent Orange exposure and
two relatively rare tumors, soft-tissue sarcomas and non-Hodgkin’s leukemia.
VA, acting on the committee’s conclusions in 1990, declared that it would
compensate veterans who developed either of those two tumors.
In 1988, congressional
leaders, led by then-Representative, now-Senator Daschle, who pushed the Agent
Orange-causes-diseases agenda, faced a dilemma. The despised CDC studies had
been negative. There was no expectation of designing a study that would differ
very much from those studies or that the results would have been different.
Congress could have
set aside the scientific findings and based its decisions on other factors --
compassion, equity, log-rolling, pork-barreling, vote-buying – or it could have
sorted among competing findings and conclusions and chosen those that satisfied
its criteria for objectivity or political usefulness. As part of the usual
course of politics and veterans compensation, Congress followed the advice of
the Zumwalt committee and declared that Agent Orange
had caused soft tissue sarcomas and non-Hodgkin’s leukemia. It went farther in
Public Law 102-4, “The Agent Orange Act of 1991,”17 passed unanimously by both the House and Senate, when it established a
committee in the Institute of Medicine (IOM), within the jurisdiction of the
prestigious National Academy of Sciences (NAS), to provide advice about health
effects of Agent Orange.
Currently in 2002, the
world exists as if the CDC and Air Force studies had never been done. Based on
conclusions from the IOM committee, the
The
IOM committee found little information to bring to bear on questions about the
health of
Currently, with some
restrictions, the VA compensates any
To its credit, the IOM
committee recently reversed its earlier decision that linked veterans’
exposures to Agent Orange with leukemia in their children. The committee
reversed itself because a mistake had been made in the single study of children
born to Australian veterans that supported the link.18 Nevertheless,
the IOM committee’s original decision that there was an association
demonstrates the members’ willing suspension of disbelief and scuttling of
scientific skepticism. There is no evidence that ground troops – including the
Australian troops – were exposed and there is no evidence from any animal or
human study that exposures of male parents can cause cancer in their offspring.
In any case, however, the IOM committee’s reversal is a welcome change. At the
time of the IOM committee’s reversal, the VA was in the process of making a
recommendation to Congress about compensating veterans’ children with leukemia,
and that process will not continue.
Far more ominous for
public policy, the IOM committee decided that there is a connection between
Agent Orange exposure and spina bifida, a birth
defect resulting in incomplete closure of the spinal column. The committee
ignored the fact that there is no evidence for any exposure to a male parent
ever having caused a birth defect and no plausible biological mechanism by which
it could do so. The spina bifida compensation
represents the first time the VA will pay for health effects in veterans’
children.
Thus, government is
now into multi-generational compensation. There’s no reason that compensation
payments must end with veterans’ children. Because evidence that convinced no
other scientific review body was sufficient to convince the IOM committee that
Agent Orange had caused a birth defect, there is no reason that equally flimsy
evidence in the future won’t convince the committee or its descendents that
Agent Orange is, somehow, causing birth defects in veterans’ grandchildren.
Indeed, some
Vietnamese scientists, just as Admiral Zumwalt made
claims about his grandson, are claiming health effects in grandchildren in their
country. In accord with an agreement signed between the
Should
the IOM decide that there is some evidence that a
A decision to
compensate grandchildren would also increase
The
most damning indictment of the IOM committee’s deliberations and conclusions
came early in March, 2002, at a meeting about Agent Orange in
Remarkably, Portier, who along with William Farland
of EPA who was also at the
On To The Gulf War.
In the 1980s and 1990s,
I heard discussions that Agent Orange was an issue because it originated in an
unpopular, un-won war and that the public felt guilty about the treatment of
the men and women who had been sent to fight that war. The Gulf War was
popular, and it was won, but plenty of health effects have been linked to it.
Almost before the war
was over, some Gulf War veterans blamed their service for essentially every
disease known to man. Unlike Vietnam veterans who fixed their blame on Agent
Orange, the Gulf War veterans have not focused on a single possible cause for
their illnesses.
The spokespersons for
Gulf War claims do, however, rely on the Agent Orange saga. Repeatedly, they
say that it took 20 years and more for Vietnam veterans to obtain justice in
the form of compensation for Agent Orange-related diseases and point to
government evasions as reasons for the delay. Gulf War veterans, they say,
demand justice sooner. After a decade of patiently examining and finding no
validity to claim after claim, the Department of Veterans Affairs and the
Department of Defense, in December 2001, accepted the argument that Gulf War
service causes Lou Gehrig’s disease. No matter that
the research was not published in a peer-reviewed journal. No matter that the
research that supposedly supports the claim was not released at the time the
decision was made. No matter that hardly anything is known about the causes of
Lou Gehrig’s disease other than that it is associated
with some heritable chromosomal alterations. No matter that no environmental
cause has been postulated for the disease. I expect that the number of Gulf
War-associated diseases will lengthen now that the first entry has been made on
the list.
“War Syndromes.”
The idea that wartime
service causes disease did not originate with
The symptoms of
fatigue and so forth were reported in all the wars, and they have been variously
attributed to psychological damage and infectious diseases. Blaming war as the
cause of long-delayed health effects, such as cancer or birth defects among
children, probably had to wait until environmental chemicals were identified,
in the public’s mind, as causes of such illnesses and birth defects.
Environmental Chemicals and Diseases.
I have written extensively
about environmental issues, and taking EPA’s data at face value, environmental
chemicals are associated with no more than about one percent of all cancers,
and probably less.22 I have not studied other diseases so intently, but I know of no data
that indicate that environmental chemicals cause birth defects. It will be a long time, however, before environmental chemicals lose
their horrific image.
The EPA constantly
warns of their risks, Members of Congress can always capture headlines by
pointing to environmental risks, and environmental organizations publicize
risks to raise money. Moreover, “chemicals cause disease” is a sure-fire news
lead.
The Future for the
The
The performance of the
The military has taken
some steps to collecting more information while troops are deployed to better
understand risks that may be encountered and any health effects caused by them. For military operations in Bosnia, which began in
1995, environmental and infectious disease surveillance teams have been
deployed; U.S. troops are being provided extensive health guidance before,
during, and after the operation; medical and psychological screening will occur
before and after deployment; and a repository for serum collected before and
after deployment is being established [from Hyams et
al., 1996].
Such efforts are
continuing, but I worry that they may backfire in the same way that the Air
Force’s study of the Ranch Hands has backfired as some members of Congress,
some veterans, and some environmentalists call it a hoax because it didn’t
confirm popular ideas about Agent Orange. Any military effort that doesn’t
support claims about adverse health effects is likely to get the same
treatment. There’s no question that such efforts must be made, however.
I have only nebulous
suggestions for what the military can do to convince its troops, veterans, and
the public that it is concerned about the health of servicemen and women, but
the charges that wartime service has caused long-delayed health effects, birth
defects, and childhood cancers are nebulous as well. In fact, the nebulousness
and plasticity of the charges make specific suggestions impossible. Here are
four ideas.
First, military
spokespeople need to be forthcoming about the terrible psychological consequences
of combat – killing, seeing friends blown apart, extended sleep deprivation,
terror, and wounds. The military has made great strides in affording treatment
and compassion to troops that suffer battle-related psychoses. Equally
important, it should take the lead in lifting stigmas that remain attached to
troops who suffer those effects. More public attention needs to be focused on
the evidence that combat neuroses and psychoses are a matter of time and
intensity of combat and not some sort of weakness or failure. Anyone seeing a
soldier suffering from physical manifestations of the psychological hell of
warfare should know they result from war-induced stress, not from the soldier’s
weakness. And the soldier should have assurances that everyone understands
that. And, of course, the physically wounded should be afforded all the
psychological support needed. I mention this here, but I don’t think that it is
a current problem.
Second, military
medicine leaders need to explain to Members of Congress and their staffsthat the evidence that environmental chemicals cause
human health effects is far from convincing. And they have to say that the
shoddy evidence is being used to pillory the military and to commit taxpayers
to paying compensation for diseases that effect every population – veteran and nonveteran – into the distant future.
Third, military
leaders need to be candid with, and about, the veterans’ service organizations.
Those organizations picture themselves as fervently patriotic, and, indeed, on
most issues they are. To the extent that they promote the fallacy that Agent
Orange caused birth defects, diseases, and deaths, they harm the military. To
the extent they promote the Gulf War Syndrome in the absence of good evidence,
they harm the military. Those organizations are placed in a difficult position
because their recruitment efforts are enhanced by their capacity to secure
benefits for members, but it might be possible to convince them to insist on
the best science before compensation decisions are made that will besmirch the
reputations of the armed services.
Fourth, there may be
opportunities to capitalize on the threat of
Finally, the military
has to be diligent about protecting its troops’ health, quick to remove them
from risky situations where that is possible, and honest about risks and health
ffects. 1 For general information about the use of Agent Orange
during the Vietnam War, see Gough, M. Dioxin, Agent Orange [
Characterization
for Dioxin-Like Compounds. Toxicological
Sciences 64 (2001): 7-13. 5 SAB, 2001. 6 Wilcox, F.A. Waiting for
an Army To Die [
8
See IOM 1994, p. 50, and references
there and Gough 1986, pp. 89-103.
As part of the legislation that mandated the Veterans Administration study,
Congress directed the Office of Technology Assessment to review and approve the
plan for the study and to monitor the conduct of the study. I was put in charge
of that activity in early 1980.
9
The Centers for Disease Control
(CDC)
10
The Centers for Disease Control
11 See, for instance, Gough, 1986, pp. 259-262.
12 Henrikson, G.L., N.S.
Ketchm, J.E. Michalek, and J.A. Swaby. Serum Dioxin and Diabetes Mellitus in Veterans of Operation Ranch
Hand. Epidemiology 8 (1997): 252-258.
13 Michalek,
J.E. and N.S. Ketchum, 23
April 2002, “Diabetes and Dioxin in Air Force Health Study Participants,”
typescript, 9 pp, prepared for the Department of Health and Human Services
advisory committee to the Ranch Hand study.
14 I chaired the Department of Health and Human Services advisory committee
to the Ranch Hand study when the decision was made to make the study data
available to the public. 15 See Institute of
Medicine 1994, p. 51, and references there.
16 Agent Orange Scientific Task Force: Human Health Effects Associated with
Exposure to Herbicides and/or Their Associated Contaminants Chlorinated
Dioxins: Agent Orange and the Vietnam Veterans. A report prepared for the
American Legion, Vietnam Veterans of America, and the National Veterans Legal
Services Project, 1990. Photocopied typescript, 55 pp.
17
Bill Summary & Status for the
102nd Congress: H.R.556, Public Law: 102-4
(02/06/91). http://thomas.loc.gov/cgibin/bdquery/D?d102:1.
18 IOM. “Revised Analysis Leads to Different Conclusion
about Agent Orange Exposure and Childhood Leukemia.” Press Release, February
27, 2002. News@nas.edu.
19 “A Killer Still.” The Economist, March 9, 2002, p. 48.
20 “U.S. Scientists Question
Vietnam Dioxin Studies.” Reuters,
March 4, 2002. Dr. Portier confirmed that he made the
“political” decision; personal communication, telephone call, April 30, 2002.
21 Hyams, K.C., F. S. Wignall, and R. Roswell. War Syndromes and their evaluation: From the U.S.
Civil War to the Persian Gulf War. Annals of Internal
Medicine (1996) 125:398-405.
22 Gough, M. How Much Cancer Can EPA Regulate Away? Risk Analysis (1990)
10:1-7.
http://web.mit.edu/ssp/Publications/working_papers/wp02-1.pdf