VA requested that IOM conduct an updated evaluation of the health effects of sarin. A new committee, made up of some of the members of the committee responsible for GW2, was convened to conduct this review.

CHARGE TO THE PRESENT COMMITTEE

The present committee was charged to review the peer-reviewed literature published since earlier IOM reports on health effects associated with exposure to sarin and related compounds, including relevant epidemiologic studies. With regard to the toxicologic literature, the committee used review articles to obtain and present a broad overview of the toxicology of sarin and cyclosarin, and to assess biologic plausibility with respect to the compounds in question and health effects; individual toxicologic research papers were evaluated as warranted. The committee based determinations on the strength of the evidence of associations between the compounds and human health effects. If published, peer-reviewed information was available on the magnitude of sarin and cyclosarin exposure of Gulf War veterans, the committee addressed the potential health risks posed to the veterans. The committee also considered other relevant issues, such as exposure to multiple chemicals and genetic susceptibilities. The committee’s review included recommendations for additional scientific studies to resolve continued scientific uncertainty as warranted.

The committee was not charged with determining whether a unique Gulf War syndrome exists, nor was it to make judgments regarding magnitudes of exposure of veterans to the putative agents. Moreover, the committee was not charged to focus on broader issues, such as the potential costs of compensation for veterans or policies regarding such compensation. Those decisions remain the responsibility of the secretary of veterans affairs. This report does, however, provide an assessment of the scientific evidence regarding health effects that may be associated with exposures to specific agents that were present in the Gulf War. The secretary may consider those health effects as the VA develops a compensation program for Gulf War veterans.

APPROACH TO THE CHARGE

The committee’s first step was to identify the literature to be reviewed. The search was conducted by using the names of sarin and cyclosarin and their synonyms. Titles and abstracts were reviewed to determine their relevance to the committee’s charge; potentially relevant studies were retrieved and evaluated. The literature was also searched for epidemiologic studies on organophosphorus (OP) compounds published and catalogued since August, 1999, when the last search was conducted for the preparation of GW2, and such studies were reviewed.

Animal studies had a small role in the committee’s assessment of association between putative agents and health outcomes. In general, animal data were used



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