Re: Agent Orange

[Tuan V Nguyen <t.nguyen@garvan.unsw.edu.au>]

Dear friends,

        I agree that this issue (Agent Orange) is a sensitive 
and emotional one, perhaps on both sides of the war. 
Nevertheless, there is a need for a proper documentation of 
its effects and consequences in Vietnam, as have been done in 
the US and Australia. However, given the hot diplomatic air 
at the moment, we have no choice, but to hold it off.

>1) This is an emotionally and politically charged issue and we will
>have to be very careful to maintain our integrity as scientists and not be
>taken in by emotions or politicians.   
>
>2) I don't know what chi. Diem Quynh does, but it seems that the other
>people are biostatisticians and mathematicians. But we need first of all 
>scientists to ask the right questions. We can at most do the study design
>but we need to know what it is that we are studying. "The association
>between birth defects and Agent Orange" is too general. None of us know
>much about either birth defect or Agent Orange. 

        From the "language" of DQ, I can deduce that DQ works 
in the field of biomedical science. I can even say that DQ 
has track record in this field. Perhaps I should stop there 
before making wild extrapolation :)

        You are right, this is a COLLECTIVE effort of 
doctors, epidemiologists, statisticians, sampling expert, 
medical scientists, etc. Aetiologically, birth defect is only 
ONE of many possible effects. What about genetic mutation and 
alteration of the endocrinological system? The list can go on 
if you check in MEDLINE.


>Judith's advice is right. But perhaps we can do some reading in the mean time.
>
>Actually, anh Tuan, do you remember that I mentioned that a doctor in the
>Pasteur Institute said that there is no data on birth defects in Vietnam (*)
>and he is interested in establishing one? I wonder if this is a good
>project. The problem is what do you count as a birth defect? Suppose
>a person has a foot which is slightly twisted. What degree of twistedness
>is normal and what degree means a defect?

	I think the merit of a project should be judged from 
the question that it is aimed to answer. So, we have to check 
to see precisely what are the issues that he want address 
with such a registration. 

	There is a saying in statistics that "garbage in, 
garbage out"; if we collect messy data, then the results of 
analyses are also likely to be shonky. Definition and 
measurement of outcomes, such as "birth defect", need to be 
carefully discussed. This can be helped by paediatric doctors 
and consulting previous literature. We can easily enlist 
experts in this field in Australia and in the US.

        Anyway, let us leave there at the moment. 


        Tuan