Among studies that examined pulmonary outcomes in association with specific exposures in the Gulf War Theater, the positive study by Cowan et al. (2002), which used objective measures of oil-well fire smoke and doctor-assigned respiratory diagnoses, is the strongest methodologically. With respect to nerve agents at Khamisiyah, no study using valid objective estimates of exposure has found statistically significant associations with pulmonary-function measures or physician-diagnosed respiratory disease.
The adequacy of the government’s response has been both praised and criticized; VA and DOD have expended enormous effort and resources in attempts to address the numerous health issues related to the Gulf War veterans. The information obtained from those efforts, however, has not been sufficient to determine conclusively the origins, extent, and long-term implications of health problems potentially associated with veterans’ participation in the Gulf War. The difficulty in obtaining meaningful answers, as noted by numerous past Institute of Medicine committees and with which the present committee agrees, is due largely to inadequate predeployment and postdeployment screening and medical examinations, and lack of monitoring of possible exposures of deployed personnel.
Predeployment and postdeployment data-gathering needs to include physician verification of data obtained from questionnaires so that one could have confidence in baseline and postdeployment health data. Collection and archiving of biologic samples might enable the diagnosis of specific medical conditions and provide a basis of later comparison. Meticulous records of all medications, whether used for treatment or prophylactically, would have improved the data and their interpretation in many of the studies reviewed.
Environmental exposures were usually not assessed directly, and that critically hampers the assessment of the effects of specific exposures on specific health outcomes. There have been detailed and laudable efforts to simulate and model exposures, but those efforts have been hampered by lack of the input data required to link the exposure scenarios to specific people or even to specific units or job categories. Moving beyond the current state requires that more detailed information be gathered during future military deployments. Specifically, working toward the development of a job-task-unit-exposure matrix, in which information on people with specific jobs or tasks or attached to specific units (according to routinely available records) is linked to exposures by expert assessment or simulation studies, would enable quantitative assessment of the effects of specific exposures.
The committee noted that several health outcomes seemed to be appearing with higher incidence or prevalence in the Gulf War-deployed veterans. For those outcomes, the committee recommends continued surveillance to determine whether there is actually a higher risk in Gulf War veterans. Those outcomes are cancer (particularly brain and testicular), ALS, birth defects