defined conditions (O’Toole et al., 1996). Various labels have been used to describe such symptom clusters, including shell shock, combat fatigue, and irritable heart; but no single etiology has been determined (Hyams et al., 1996).

In addition to the threat or experience of combat, the Gulf War involved rapid and unexpected deployment, harsh living conditions, and continuous anticipation of exposure to chemical and biologic agents, environmental pollution from oil-well fires, and family disruption and financial strain. Each of those stressors—let alone all of them combined—may have had adverse effects on the health of many Gulf War veterans (IOM, 2001).

The committee, in responding to its charge, reviewed the literature on the agents associated with service in the Gulf War; it did not review the totality of the war experience (including pre- and post-deployment). The committee looked exclusively at the putative agents as though each one were the only risk factor for adverse health effects. The committee recognizes, however, that it might be important to look at the totality of the experience of war and its stressors, as well as at specific biologic, chemical, and radiologic exposures.

ORGANIZATION OF THE REPORT

Chapter 2 discusses the steps taken to identify and evaluate the literature and the criteria established by the committee to make conclusions of association. It also highlights many of the complex issues considered by the committee as the literature was reviewed. Chapters 3 and 4 are overviews of the toxicology of the relevant insecticides and solvents, respectively, and provide information on their short-term health effects in humans. Chapters 59 provide the committee’s in-depth review of the epidemiologic studies of exposure to insecticides and solvents with regard to long-term adverse health effects. They present the committee’s conclusions about the strength of the association between the putative agents and cancer (Chapters 5 and 6), neurologic effects (Chapter 7), reproductive effects (Chapter 8), and other health effects, such as dermatologic, renal, and hepatic outcomes (Chapter 9). There are several appendices in the report: Appendix A provides a discussion of the numerous studies of Gulf War veterans; the information offers background for the reader and provides a context for members of the IOM committee. Appendix B provides the conclusions and recommendations from Gulf War and Health, Volume 1. Appendix C provides a discussion of the methods used in searching the literature, while Appendix D includes a list of all insecticides and solvents identified as having been sent to the Persian Gulf. Appendix E provides a discussion and table of expected relative risks for lung cancer due solely to smoking for selected scenarios regarding the prevalence of smoking in the occupational cohort and in the general population. Appendix F describes the numerous neurologic tests that are used to diagnose neurologic health outcomes. Appendix G presents the committee’s conclusions organized by health outcome rather than by category of association.



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