[ RadSafe ] [Fwd: three questions on "Reproductive health of Gulf War veterans"]

Steven Dapra sjd at swcp.com
Tue Mar 28 20:43:05 CST 2006

March 28

         Today I read the Kang, H., et al. paper that Salsman invokes below.

         Concerning the incidence of birth defects it says:

         " . . . male Gulf veterans reported infants with likely birth 
defect(s) at nearly twice the rate of controls (adjusted OR = 1.94; 95% CI 
= 1.37-2.74).  . . .  Female Gulf veterans were almost three times more 
likely to have a child with a likely birth defect than non-Gulf females, 
after adjusting for other factors (adjusted OR = 2.97; 95% CI = 
1.47-5.99)."  (p. 507)  (The controls were non-Gulf veterans, as noted on 
p. 505.)

         This study was based on data gathered in a 16-page questionnaire, 
that was re-sent to non-respondents at ten weeks, and again at six 
months.  Further followup on non-respondents was conducted via 
telephone.  "Veterans were asked to describe the birth defect, and to 
indicate cause and date for infant deaths.   . . .   All analyses of 
pregnancy outcomes were based on veteran self-reported outcome data and no 
validation of these reported outcomes with medical records was made."  (p. 505)

         In their Discussion (p. 507-510), the authors describe some 
additional analyses they conducted to try and filter out or account for 
possible reporting bias.  They also state:  "A third limitation of the 
study is that we were unable to evaluate specific defects, which may be 
etiologically different.  Bcause of the dearth of documented information 
regarding specific exposures of particular veterans and the lack of 
knowledge on the human teratogenicity of most of the reported exposures, we 
were unable to evaluate which exposures might be associated with which 
outcomes."  (p. 509)

         In their Conclusions to their untitled abstract, the authors say, 
"This observation [of birth defects associated with Gulf War service] needs 
to be confirmed by a review of medical records to rule out possible 
reporting bias."  (p. 504)

Steven Dapra
sjd at swcp.com

At 11:26 AM 3/26/06 -0800, you wrote:
>Date: Sun, 26 Mar 2006 02:56:27 -0800
>Dear Drs. Doyle and Ryan:
>I read your paper, "Reproductive health of Gulf War veterans,"
>in Phil. Trans. R. Soc. B (2006) 361, 571­584, with interest and
>On page 574 you state that Kang, H., et al. (2001) in "Pregnancy
>outcomes among US Gulf war veterans: a population-based survey
>of 30,000 veterans" Ann. Epidemiol. 11, 504­511, "reported some
>evidence of a modest increase in risk of birth defect for male
>veterans' offspring...."
>In fact, didn't Kang et al. report a near-doubling for birth
>defect risk in male veterans' offspring and a near-tripling for
>female veterans' offspring?
>Why did you omit mention of the female veterans' birth defect rate?
>Why does Dr. Ryan continue to refuse to release the U.S. data
>subsequent to 2000?
>James Salsman

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