Review Of Report And Approach To Evaluating Long Term Health Effects In Army Test Subjects

Between 1942 and 1975, the U.S. Army conducted tests with human subjects to study the effects of a variety of agents, including chemical warfare and biological agents. The potential long-term health effects on the test subjects from their exposures have been evaluated periodically, most recently in a report titled Assessment of Potential Long-Term Health Effects on Army Human Test Subjects of Relevant Biological and Chemical Agents, Drugs, Medications and Substances: Literature Review and Analysis (the Report), which was prepared by a contractor to assist the Army with making determinations about providing medical care to former test subjects. In response to a request by the Army, the National Academies of Sciences, Engineering, and Medicine formed a committee that was tasked with examining whether the Report appropriately identified potential long-term health effects from exposure to the test agents and whether an adequate weight-of-evidence approach was used to characterize the strength of the associations between the agents and their potential health effects. The committee was made aware at its first meeting on November 30, 2017, that the Army had already begun to receive applications for medical care and that some determinations may need to be made before the committee's evaluation of the Report was completed. Because of this urgency, the Army developed a process by which applications for medical care will be reviewed, and as a result, the committee was given the additional task of reviewing the Army's Memorandum that describes the approach that will be used by the Army to evaluate agent- and outcome-specific associations. This interim report was prepared to facilitate the Army's deliberations. A review of the Report is presented first, followed by a review of the Memorandum.

"Between 1942 and 1975, the U.S. Army conducted tests with human subjects to study the effects of a variety of agents, including chemical warfare and biological agents. The potential long-term health effects on the test subjects from their exposures have been evaluated periodically, most recently in a report titled Assessment of Potential Long-Term Health Effects on Army Human Test Subjects of Relevant Biological and Chemical Agents, Drugs, Medications and Substances: Literature Review and Analysis (the Report), which was prepared by a contractor to assist the Army with making determinations about providing medical care to former test subjects. In response to a request by the Army, the National Academies of Sciences, Engineering, and Medicine formed a committee that was tasked with examining whether the Report appropriately identified potential long-term health effects from exposure to the test agents and whether an adequate weight-of-evidence approach was used to characterize the strength of the associations between the agents and their potential health effects. The committee was made aware at its first meeting on November 30, 2017, that the Army had already begun to receive applications for medical care and that some determinations may need to be made before the committee's evaluation of the Report was completed. Because of this urgency, the Army developed a process by which applications for medical care will be reviewed, and as a result, the committee was given the additional task of reviewing the Army's Memorandum that describes the approach that will be used by the Army to evaluate agent- and outcome-specific associations. This interim report was prepared to facilitate the Army's deliberations. A review of the Report is presented first, followed by a review of the Memorandum"--Publisher's description.

Trichloroethylene (TCE) is a solvent that is used as a degreasing agent, a chemical intermediate in refrigerant manufacture, and a component of spot removers and adhesives. It is produced in mass quantities but creates dangerous vapors and is an environmental contaminant at many industrial and government facilities, including facilities run by the U.S. Department of Defense (DoD). It is important to determine the safe occupational exposure level (OEL) for the solvent in order to protect the health of workers who are exposed to its vapors. However, there are concerns that the current occupational standards insufficiently protect workers from these health threats. Review of DOD's Approach to Deriving an Occupational Exposure Level for Trichloroethylene makes recommendations to improve the DoD's approach to developing an OEL for TCE, strengthen transparency of the process, and improve confidence in the final OEL value. This report reviews the DoD's approach using a literature review, evidence synthesis based on weight of evidence [WOE], point-of-departure derivation, physiologically based pharmacokinetic modeling, extrapolation tools, and explores other elements of the process of deriving an OEL for TCE. It examines scientific approaches to developing exposure values and cancer risk levels, defining the scope of the problem, and improving hazard identification.

In the 1970s, flame retardants began to be added to synthetic materials to meet strict flammability standards. Over the years, diverse flame retardants have been manufactured and used in various products. Some flame retardants have migrated out of the products, and this has led to widespread human exposure and environmental contamination. There also is mounting evidence that many flame retardants are associated with adverse human health effects. As a result, some flame retardants have been banned, restricted, or voluntarily phased out of production and use. This publication develops a scientifically based scoping plan to assess additive, nonpolymeric organohalogen flame retardants as a class for potential chronic health hazards under the Federal Hazardous Substances Act, including cancer, birth defects, and gene mutations.

The National Toxicology Program (NTP) conducted a systematic review of the evidence of adverse neurodevelopmental and cognitive effects of fluoride exposure. NTP's conclusions are summarized in the monograph Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects. At the request of NTP, a committee convened by the National Academies reviewed their monograph to ensure the integrity of that report. It is important to note that the committee was tasked with reviewing the monograph and focused its efforts on evaluating whether evidence as presented in the monograph supported NTP's conclusions. Thus, it did not conduct its own independent evaluation of the evidence, and it did not conduct a data audit. However, it did review some key literature to enable its review of the monograph. Review of the Draft NTP Monograph contains findings and suggestions for improvements and some overarching findings concerning methods, assessment of animal and human evidence, and NTP's hazard conclusion.