Sources of radiation: uranium, depleted uranium, microwave radiation, and radiofrequency radiation

Diseases endemic to the region: leishmaniasis, sandfly fever, pathogenic Escherichia coli, and shigellosis

Administration of live, “attenuated,” and toxoid vaccines.

In response to VA and Congress, IOM determined that the study would be conducted in phases and that the initial phase would include a review of the agents that were of most concern to the veterans. After meetings with Gulf War veterans, the first IOM Gulf War committee decided that its study would focus on depleted uranium, pyridostigmine bromide, sarin, and vaccines (anthrax and botulinum toxoid).

After reviewing IOM’s Gulf War and Health, Volume 1, the secretary of veterans affairs determined that there was no basis to establish a presumption of a connection between Gulf War exposure to sarin, pyridostigmine bromide, depleted uranium, or anthrax or botulinum toxoid vaccine and various health outcomes.

SCOPE OF VOLUME 2

This second volume focuses on long-term adverse health outcomes associated with exposure to insecticides and solvents. The IOM committee that was formed to conduct the second study began its work by overseeing extensive searches of the peer-reviewed medical and scientific literature. The searches retrieved about 30,000 potentially relevant references which were considered by the committee and staff. After an assessment of the references, the committee focused on about 3000 that analyzed the relevant insecticides and solvents and their long-term adverse health effects in humans. The committee did not review the literature on short-term outcomes, inasmuch as the veterans, their families, VA, and Congress are concerned with health effects that might persist long after exposure ceased and that might require compensation.

It should be noted that the charge to IOM was not to determine whether a unique Gulf War syndrome exists or to judge whether veterans were exposed to the putative agents. Nor was the charge to focus on broader issues, such as the potential costs of compensation for veterans or policy regarding such compensation; that policy is the responsibility of the secretary of veterans affairs. The committee’s charge was to assess the scientific evidence regarding long-term health effects associated with exposure to specific agents that were potentially present during the Gulf War. Epidemiologic studies that analyzed the relationship between exposure to specific chemicals under review and long-term health outcomes provided the evidence for the committee to use in drawing conclusions of association.

METHODS

As the committee began its task, the first step was to broadly identify the literature for review. Searches were conducted by using the names and synonyms of the specific insecticides and solvents identified for study, their Chemical Abstract Service registry numbers, and the relevant classes of insecticides and solvents. Searches were also conducted on occupations with known exposure to insecticides or solvents (such as pesticide application, painting, and dry



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