by Don Finley, Express-News Medical Writer
For 25 years, a close-knit group of Vietnam veterans has come together every few years to contribute bits of flesh and bodily fluids to help answer a grim question: Did exposure to the herbicide known as Agent Orange leave them — or their children — sicker than other people?
Those contributions — more than 90,000 samples — fill two long banks of freezers in a dimly lit room at Brooks City-Base. The rest of the room is filled with empty shelves, the medical histories that once occupied them — 1,987 boxes — already shipped to the National Personnel Records Center in St. Louis.
On Sept. 30, the Air Force Health Study will officially end, the money — at least $143 million — run out. Requested by Congress, headquartered in San Antonio, overseen by the National Academy of Sciences and often mired in controversy, the study resulted in dozens of published papers in scientific journals. A few papers are still being written.
The most notable finding so far is that those who absorbed the highest levels of dioxin — the main toxin in Agent Orange — had a higher risk of developing diabetes.
Within days, the fate of those samples — described as a “national treasure” by one caretaker — will be decided as the Institute of Medicine, a branch of the NAS, decides where to move them, and a bill making its way through Congress would set aside money for their safekeeping for years to come.
If the money — a total of about $1.6 million a year — is not appropriated, the samples could be destroyed. If the money is approved, scientists from across the country could study the materials if their ideas were deemed worthy by an expert panel.
Julie Robinson, transition manager of the Air Force Health Study, stands at the end of a row of shelves that once contained medical files concerning Vietnam veterans exposed to Agent Orange and their children. The files are in the process of being moved.
“Epidemiological researchers salivate over the notion that you might have repeated samples from a single individual over a 20-plus-year span,” said David Butler, a senior program officer with the Institute of Medicine. “It’s just very rare to have that kind of information available, and it allows you to do some wonderful studies that can’t otherwise be done without great investment in time and money.”
‘They were lousy shots’
At one time or another, 1,269 pilots and crew members served in Operation Ranch Hand, a volunteer Air Force unit that swooped low and slow over dense forests and rubber plantations, spraying an estimated 10 percent of South Vietnam with leaf-killing chemicals to deny the Viet Cong a place to hide.
It was among the most dangerous jobs of the war, and the unit among the most iconoclastic. Its members were famous for wearing purple scarves around their neck — sort of a combination fashion statement, good-luck charm and middle finger to the enemy.
“We sprayed this crap over there for about nine years, from 1961 to 1970,” said Ralph Dresser, a pilot who commanded the unit in the mid-1960s and flew some 350 missions. “We lost 26 crew members and we lost nine airplanes, mostly to ground fire. We were recognized as the most shot-at and the most hit outfit over there. And the reason was, we flew just like a stateside crop duster —about 150 feet off the ground and about 150 knots.
“Fortunately, they were lousy shots,” he said, adding: “I say that, and I have to admit that my guys that were there, over half of them were wounded at least once — some up to three times.”
A variety of herbicides, identified by colored bands around 55-gallon barrels, were used. Agent Orange was the most common.
The squadron flew C-123 cargo planes, each carrying 1,000-gallon tanks. The cockpit side windows remained open, as did a door in the fuselage so the flight mechanic who operated the equipment could drop smoke grenades for support aircraft to fire on enemy positions.
But it was the ground crew who had the highest dioxin exposures, because they had to transfer the herbicides by hand with pumps and clean the tanks.
Dresser, 76, today is fire marshal of Bandera County. He doesn’t believe that the herbicide caused health problems to his men or the soldiers on the ground, and has little patience with those who do.
Forty years have passed, he argues, since he flew those missions, and 90 percent of the Ranch Hands are still alive. None wore protective gear while handling the material.
When he commanded the unit, people occasionally would ask if the herbicide was safe. He would dip his fingers into the barrel and moisten his lips with it.
“It was stupid. It tasted like hell.” But he adds: “The best medical science says that our group is at least as healthy, if not healthier, than the comparison group. What does that tell you about this concern that Herbicide Orange is destroying everybody?”
The defoliation program was controversial almost from the start. Some scientific groups expressed concern about the health risks of the herbicides while the program was under way. The Centers for Disease Control and the NAS were asked to study it. Only the Air Force stepped forward.
To allay concerns that the Air Force couldn’t be trusted to find the truth, an expert, independent panel of scientists and veterans would oversee the study.
The Air Force surgeon general attended an early reunion of the Ranch Hands and asked them to participate, Dresser recalled. Most did. A comparison group of Vietnam Air Force veterans who served elsewhere in Vietnam was recruited as well.
“Since its inception, the Ranch Hand study has been controversial,” a 1999 GAO report stated. “For instance, news articles and statements in the Congressional Record have alleged that government officials delayed and withheld information on the study’s findings, improperly influenced the study’s design and implementation, and failed to provide adequate veterans’ representation on the Advisory Committee.”
Joel Michalek, a civilian scientist working for the Air Force, helped design the study three years after the war ended and served as its scientific director for most of the project.
There was little interference from higher-ups, said Michalek, now a professor of epidemiology at the University of Texas Health Science Center. There was too much oversight, with Congress, the Institute of Medicine and an oversight committee all combing through the findings and data. The University of Texas School of Public Health in Houston consulted on the study design.
Six times — in 1982, 1985, 1987, 1992, 1997 and 2002 — the entire group was flown to a single location for extensive physical exams, where X-rays, blood and blood components, urine, semen and even some fat cells were taken. Thorough medical histories on both the airmen and their children were recorded. Because memories were faulty, a team of researchers spent three years tracking birth certificates and medical records of the children.
Each year, it became harder to examine them, said Julie Robinson, the current chief of the study. “The youngest was born in 1950. The oldest is in his 90s. So logistically, getting these men to one site as they continue to age requires escorts, special equipment, like oxygen in flight.” It also would make it difficult to continue the existing study.
The first major paper, published in the Journal of the American Medical Association in 1990, found no differences between the Ranch Hands and the comparison group in terms of cancer deaths, heart disease or other problems. Air Force officials described the results as “reassuring” — a judgment that later drew criticism from the GAO.
“Although the Air Force no longer uses such language, it still reports findings to the public through press releases and executive summaries that do not make the study’s limitations clear,” the 1999 report said, adding that the relatively small size of the study group made it almost impossible to detect higher rates of less common cancers and other diseases.
A surprising finding
But in 1997, Michalek reported that Ranch Hands suffered a 50 percent higher-than-expected rate of diabetes. It was a completely unexpected finding. And a smaller association with spina bifida, a neural tube birth defect, also was found. The findings prompted the Department of Veterans Affairs to make those conditions eligible for compensation among Vietnam veterans.
With the study running down, an Institute of Medicine committee last year recommended in a 264-page report that the records and biological samples from the Air Force Health Study be saved and made available to other scientists. Electronic copies of the documents also exist.
When the IOM report was released, Michalek wrote a lengthy proposal seeking to keep the materials in San Antonio through a consortium that included the health science center and Texas A&M and Texas Tech universities. His proposal was delivered by the UT legislative liaison to key members of Congress with interests in veterans issues, including Sen. John McCain, R-Arizona. There was no response from anyone.
“That’s the end of it, as far as I’m concerned,” said Michalek, who is preparing a final paper from the study.
Baker said the IOM has a place in mind to move the specimens, and is working out the details. He declined to say yet where it would be, but noted that the location would be a repository without any decision-making authority over what is done with them or who gets to use them. That authority would lie with the Medical Follow-Up Agency, a division of the IOM.
The samples will be moved, he added, if Congress passes the appropriations bill filed by Sen. Daniel Akaka, D-Hawaii, chairman of the Veterans’ Affairs Committee. “Absent support, I don’t want to think what might happen to the biospecimens, certainly,” Baker said.
In the meantime, Dresser says he has concerns about opening up his personal medical records and specimens to other scientists. The Ranch Hands have been asked to sign new consent forms for the transfer. He hasn’t yet decided if he will.
“I’m still open if they can convince me those things will be safeguarded to where some crackpot won’t get hold of them and distort the results,” Dresser said, adding he was proud of his 25-year involvement in the research. “It was a great study. But the trouble with the study is nobody wants to believe the results.”