Monday, January 26, 2009

Report: Gulf War Illness and the Health of Gulf War Veterans

The Research Advisory Committee on Gulf War Veterans' Illnesses released the report Gulf War Illness and the Health of Gulf War Veterans, in November 2008.

This massive (465 page) report summarizes and references the science known to date, in language that's reasonably easy to read (there's just a lot of it).

The Report's Findings In Brief

"Gulf War illness, the multisymptom condition resulting from service in the 1990-1991 Gulf War, is the most prominent health issue affecting Gulf War veterans, but not the only one.The Congressionally mandated
Research Advisory Committee on Gulf War Veterans’ Illnesses has reviewed the extensive evidence now available, including important findings from scientific research and government investigations not considered by earlier panels, to determine what is known about the health consequences of military service in the Gulf War. This evidence identifies the foremost causes of Gulf War illness,
describes biological characteristics of this condition, and provides direction for future research urgently needed to improve the health of Gulf War veterans.

Gulf War illness is a serious condition that affects at least one fourth of the 697,000 U.S. veterans who served in the 1990-1991 Gulf War. This complex of multiple concurrent symptoms typically includes persistent memory and concentration problems, chronic headaches, widespread pain, gastrointestinal problems, and other chronic abnormalities not explained by well-established diagnoses. No effective treatments have been identified for Gulf War illness and studies indicate that
few veterans have recovered over time.

Gulf War illness fundamentally differs from trauma and stress-related syndromes described after other wars. Studies consistently indicate that Gulf War illness is not the result of combat or other stressors and that Gulf War veterans have lower rates of posttraumatic stress disorder than veterans of other wars. No similar widespread, unexplained symptomatic illness has been identified in veterans who have served in war zones since the Gulf War, including current Middle East deployments.

Evidence strongly and consistently indicates that two Gulf War neurotoxic exposures are causally associated with Gulf War illness: 1) use of pyridostigmine bromide (PB) pills, given to protect troops from effects of nerve agents, and 2) pesticide use during deployment. Evidence includes the consistent association of Gulf War illness with PB and pesticides across studies of Gulf War veterans, identified dose-response effects, and research findings in other populations and in animal models.

For several Gulf War exposures, an association with Gulf War illness cannot be ruled out. These include low-level exposure to nerve agents, close proximity to oil well fires, receipt of multiple vaccines, and effects of combinations of Gulf War exposures. There is some evidence supporting a possible association between these exposures and Gulf War illness, but that evidence is inconsistent or limited in important ways.

Other wartime exposures are not likely to have caused Gulf War illness for the majority of ill veterans. For remaining exposures, there is little evidence supporting an association with Gulf War illness or a major role is unlikely based on what is known about exposure patterns during the Gulf War and more recent deployments. These include depleted uranium, anthrax vaccine, fuels, solvents, sand and particulates, infectious diseases, and chemical agent resistant coating (CARC).

Gulf War illness is associated with diverse biological alterations that most prominently affect the brain and nervous system. Research findings in veterans with Gulf War illness include significant differences in brain structure and function, autonomic nervous system function, neuroendocrine and immune measures, and measures associated with vulnerability to neurotoxic chemicals. There is little evidence of peripheral neuropathies in Gulf War veterans.

Gulf War illness has both similarities and differences with multisymptom conditions in the general population. Symptom-defined conditions like chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity occur at elevated rates in Gulf War veterans, but account for only a small proportion of veterans with Gulf War illness.

Studies indicate that Gulf War veterans have significantly higher rates of amyotrophic lateral sclerosis (ALS) than other veterans, and that Gulf War veterans potentially exposed to nerve agents have died from brain cancer at elevated rates. Although these conditions have affected relatively few veterans, they are cause for concern and require continued monitoring.

Important questions remain about other Gulf War health issues. These include questions about rates of other neurological diseases, cancers, and diagnosed conditions in Gulf War veterans, current information on overall and disease-specific mortality rates in Gulf War veterans, and unanswered questions concerning the health of veterans’ children.

Federal Gulf War research programs have not been effective, historically, in addressing priority issues related to Gulf War illness and the health of Gulf War veterans. Substantial federal Gulf War research funding has been used for studies that have little or no relevance to the health of Gulf War veterans, and for research on stress and psychiatric illness. Recent Congressional actions have brought about promising new program developments at the Departments of Defense and Veterans Affairs, but overall federal funding for Gulf War research has declined dramatically since 2001.

A renewed federal research commitment is needed to identify effective treatments for Gulf War illness and address other priority Gulf War health issues. Adequate funding is required to achieve the critical objectives of improving the health of Gulf War veterans and preventing similar problems in future deployments. This is a national obligation, made especially urgent by the many years that Gulf War veterans have waited for answers and assistance."

---from Gulf War Illness and the Health of Gulf War Veterans


Hardcopy of this report is available by Contacting the Committee.

About the Committee

"The Research Advisory Committee on Gulf War Veterans' Illnesses was created by Congress in 1998, and first appointed by Secretary of Veterans Affairs Anthony J. Principi in January, 2002. The mission of the Committee is to make recommendations to the Secretary of Veterans Affairs on government research relating to the health consequences of military service in the Southwest Asia theater of operations during the Persian Gulf War.

According to its charter, the guiding principle for the work of the Committee shall be the premise that the fundamental goal of Gulf War-related government research is to improve the health of ill Gulf War veterans. Research priorities will be judged against this standard."

--- from the Committee's website

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