By Donna Miles
American Forces Press Service
Aug. 6, 2009 - As the military prepares to step up its already robust environmental health monitoring program to identify possible health consequences of "burn pit" smoke exposures in the combat theater, President Barack Obama has pledged to ensure troops are protected, and any related ailments treated. "I'm absolutely convinced that our commanders in theater are doing everything they can to protect their men and women," the president told military reporters during a roundtable interview earlier this week at the White House.
But as the facts are sorted out -- an evolving process as more samples are collected and scientific data generated -- Obama vowed to bring them to light so they can benefit servicemembers and veterans.
"My overriding mandate to my agencies is that you get the best science possible, and then you make decisions on how we can protect our men and women in uniform," he said. "How can we treat those who have been harmed?"
At issue are open-air "burn pits" initially constructed in the combat theater to dispose of solid wastes. Force protection issues during the combat phases of Operation Iraqi Freedom precluded hauling this waste off base for destruction, explained Dr. Craig Postlewaite, the Pentagon's force readiness and health assurance director, assigned to the office of the deputy assistant secretary for force health protection and readiness.
Some troops who were deployed near these pits blame the smoke they emitted for causing respiratory problems, blood disorders and other ailments.
While conceding that these servicemembers and veterans have genuine health issues, Postlewaite said none of the data gathered so far provides concrete evidence that burn pit smoke is the culprit.
A "very robust" occupational and environmental health surveillance program that's collected more than 17,000 air, water and soil samples where U.S. troops are operating didn't raise any big concerns, he said.
Neither did an extensive screening health-risk assessment at Joint Base Balad, home of the theater's largest burn pit. Those tests, conducted in 2007 and completed last year, used sophisticated sampling devices to collect 163 representative samples over a four-month period, Postlewaite explained.
Pentagon scientists applied Environmental Protection Agency methods to evaluate 4,000 different data points. They took the different smoke concentrations gathered and considered the worst-case -- and as Postlewaite pointed out, nearly implausible -- scenario: that someone had been exposed to those smoke levels 24 hours a day, seven days a week for up to a year.
The evaluation confirmed that burn-pit smoke is irritating, causing some people to experience red, watery eyes, tickly throats and coughing, among other symptoms. But based on the data collected, evaluators could not identify any long-term health risks, including cancer, Postlewaite reported.
The Pentagon wanted its findings validated by an independent third party, so it sent them to the Defense Health Board for review. The board, made up of noted experts in the field, agreed with the Pentagon's findings. "They did not see any long-term, elevated health risk," Postlewaite said.
Postlewaite conceded there could be holes in the findings. The study was based on four months of sampling. It included just one burn pit, albeit the largest, and covered only what was being burned during the sampling period. And there's simply no way to go back in time to replicate the exact conditions some troops were exposed to at an earlier time.
On top of this, there's a proven historic link between deployments and respiratory disease, Postlewaite said. Rates went up for troops who deployed to the Middle East during the Gulf War and to Bosnia as part of the NATO security force. New environments mean new allergens, new viruses and other new conditions that affect the respiratory system.
Other factors come into play, too, Postlewaite said. What's simply irritating to one person might cause more chronic conditions in another. The reason may be genetic. It may be linked to a previous respiratory infection or other reduced immunity, or it could be linked to smoking.
"These are difficult, difficult questions to answer, even here in this country where we have a huge public health infrastructure," Postlewaite said. "But we are going to do our best to tease this apart."
So the Defense Department is stepping up its testing of burn pit smoke. U.S. Central Command has asked for help to put together a monitoring plan so it can collect air samples at additional burn pits in Iraq as well as Afghanistan
Many used earlier in the war have been replaced by incinerators. Joint Base Balad now has four incinerators, and its burn pit is expected to close soon.
A broad Defense Department effort is focusing on the issue, bringing together the expertise embodied in the Armed Forces Health Surveillance Center, the Defense Department's Deployment Health Research Center, the U.S. Army Center for Health Promotion and Preventive Medicine and the Air Force School of Aerospace Medicine.
Postlewaite called getting to the bottom of the issue a responsibility to the troops, and said the Defense Department will lay its findings on the line.
"We are absolutely open to full transparency," he said. "Our job is to protect the health of servicemembers, and clearly, if we have information that indicates that they are at risk, that information will be shared and measures will be implemented to reduce or eliminate the risks."
Obama made it clear at the White House roundtable he wants to get the information out as it becomes available. "I don't want us hiding the ball if there is a real problem there," he said.
Veterans Affairs Secretary Eric K. Shinseki, who joined Obama at the roundtable, said he doesn't want burn pits to become this generation's Agent Orange -- a reference to the defoliant used in Vietnam that's been linked to cancer and other medical problems.
VA is working with the Defense Department "to do the kinds of sampling we didn't do for Agent Orange," he said, and comparing samples of servicemembers exposed to burn pit smoke with those of veterans who weren't.
VA also may consider expanding its mandatory screening for brain injuries and stress disorders to include a screening for burn pit smoke exposure, he said. The idea, Shinseki said, is to identify problems early and get veterans the treatment they need.
"I can tell you, part of my frustration is dealing with the issues of Agent Orange 40 years after the last use of Agent Orange," he said. "So my interest is, 'How do we change what has been the 40-year journey of Agent Orange, the 20-year journey of Gulf War Illness" and prevent a similar journey for burn pit smoke?