Submission For The Record of Institute of Medicine
Mme Chairwoman and members of the Subcommittee on Health, my name is Harvey V. Fineberg. I am the President of the Institute of Medicine of the National Academies. The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public.
Established in 1970, the IOM is the health arm of the National Academy of Sciences, which was chartered under President Abraham Lincoln in 1863. Today, the National Academy of Sciences has expanded into what is collectively known as the National Academies, which comprises the National Academy of Sciences, the National Academy of Engineering, the National Research Council, and the IOM.
I have been asked by your subcommittee to submit a statement for this hearing on the topic of H.R. 3337, the Open Burn Pit Registry Act of 2011. Our service men and women have long indicated concern that their health may have been adversely impacted by the burning of solid waste in open pits at US bases overseas where they were or are stationed. This concern has been echoed by Congress and the Department of Veterans Affairs. In 2009 the IOM was asked by the Department of Veterans Affairs to assess the long-term health risks from open pit burning at bases in Iraq and Afghanistan, using Joint Base Balad (JBB) near Baghdad, one of the largest military bases in Iraq, as an example.
IOM convened an expert committee to study this matter and the committee completed their report in 2011. A PDF download of this report is available to the public at no charge from the National Academy Press at the following web address: [ http://www.nap.edu/catalog.php?record_id=13209].
I am submitting a copy of the summary of this IOM report for the record here. Briefly, the IOM collected data on environmental releases and concentrations of combustion products at JBB, considered information on possible human exposures at the base and elsewhere, and assessed the potential for long-term health effects of those exposures. The Department of Defense provided raw air-sampling data from JBB taken when the burn pit was in operation (it has since been replaced by incinerators), which were used to determine which chemicals were present at JBB. Based on these data, the committee found that levels of most pollutants at the base were not higher than levels measured at other polluted sites worldwide.
However, insufficient evidence prevented the IOM committee from developing firm conclusions about what long-term health effects might be seen in service members exposed to burn pits. Along with more efficient data-gathering methods, the report recommends that a study be conducted that would evaluate the health status of service members from their time of deployment to JBB over many years to determine the incidence of chronic diseases, including cancers, that tend to show up decades after exposure. Given the many hazards to which military personnel are exposed in the field, service in Iraq and Afghanistan in general, rather than exposure to burn pits only, might be associated with long-term adverse health effects.
In addition to instructing the Department of Veterans Affairs to establish a health registry, the proposed H.R. 3337 instructs the Secretary, Department of Veterans Affairs to enter into an agreement with an independent scientific organization to accomplish tasks outlined in Section 3 of the legislation. I will offer brief comments about those tasks. The three tasks are appropriate and feasible for an independent scientific organization to accomplish. For example, the first task is to assess of the effectiveness of actions taken by the Secretaries (Defense and Veterans Affairs) to collect and maintain information on the health effects of exposure to toxic chemicals and fumes caused by open burn pits. The independent organization could invite the Secretaries to review with the external independent organization in a public venue, their plans and programs for carrying out the legislation’s requirements. That review would include assessing the completeness of a toxic agents inventory that the Secretary, Department of Veterans Affairs, believes is associated with the open burn pits, how and where the information is being derived and maintained, and how accessible it is to veterans included in the registry. This assessment would naturally lead to a set of recommendations (the second task) to improve the collection and maintenance of such information. Finally, the third task requires an independent organization to review epidemiological studies, established and previously published, and to offer recommendations regarding the most effective and prudent means of addressing the medical needs of eligible individuals with respect to conditions that are likely to result from exposureto open burn pits. An independent scientific organization would be able to scour the world literature for relevant articles relating to this topic.
Depending on the nature of the information discovered, the independent organization could ascertain which exposures might present the most significant potential long-term health risks. That, in turn, would lead to recommendations about how best to prevent or clinically manage these potential effects. If little or no information could be obtained from a comprehensive literature review, the independent organization could suggest new research, epidemiological and otherwise, to inform the health risks.
In sum, the tasks outlined in section 3 of H.R. 3337 can be accomplished by a credible independent organization. Thank you for the opportunity to submit a statement for the record.