National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×

GULF WAR and HEALTH

VOLUME 4

HEALTH EFFECTS OF SERVING IN THE GULF WAR

Committee on Gulf War and Health: A Review of the Medical Literature Relative to the Gulf War Veterans’ Health

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×

THE NATIONAL ACADEMIES PRESS

500 Fifth Street, NW Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract V101(93)P-2155 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

International Standard Book Number-10: 0-309-10176-X

International Standard Book Number-13: 978-0-309-10176-9

Library of Congress Control Number: 2006934960

Additional copies of this report are available from the

National Academies Press,

500 Fifth Street, NW, Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu.

Copyright 2006 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×

THE NATIONAL ACADEMIES

Advisers to the National on Sciences, Engineering, and Medicine


The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.


The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.


The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.


The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×

COMMITTEE ON GULF WAR AND HEALTH: A REVIEW OF THE MEDICAL LITERATURE RELATIVE TO GULF WAR VETERANS’ HEALTH

LYNN R. GOLDMAN, MD, MPH, (chair) Professor,

Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

MARCIA ANGELL, MD, Senior Lecturer on Social Medicine,

Department of Social Medicine, Harvard Medical School, Boston, MA

W. KENT ANGER, PhD, Associate Director for Occupational Research,

Center for Research on Occupational and Environmental Toxicology, Oregon Health and Science University, Portland, OR

MICHAEL BRAUER, ScD, Professor,

School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia

DEDRA S. BUCHWALD, MD, Director,

Harborview Medical Center, University of Washington, Seattle, WA

FRANCESCA DOMINICI, PhD, Associate Professor,

Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

ARTHUR L. FRANK, MD, PhD, Professor, Chair,

Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA

FRANCINE LADEN, ScD, Assistant Professor of Medicine,

Channing Laboratory, Harvard Medical School, Boston, MA

DAVID MATCHAR, MD, Director,

Center for Clinical Health Policy Research, Duke University Medical Center, Durham, NC

SAMUEL J. POTOLICCHIO, MD, Professor,

Department of Neurology, George Washington University Medical Center, Washington, DC

THOMAS G. ROBINS, MD, MPH, Professor,

Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI

GEORGE W. RUTHERFORD, MD, Professor, Vice-Chair,

Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, School of Medicine, University of California, San Francisco, CA

CAROL A. TAMMINGA, M.D., Professor,

Department of Psychiatry, University of Texas, Southwestern Medical Center, Dallas, TX

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×

STAFF

CAROLYN FULCO, Senior Program Officer

ABIGAIL MITCHELL, Senior Program Officer

DEEPALI PATEL, Senior Program Associate

MICHAEL SCHNEIDER, Senior Program Associate

JUDITH URBANCZYK, Senior Program Associate

HOPE HARE, Administrative Assistant

PETER JAMES, Research Associate

DAMIKA WEBB, Research Assistant

RENEE WLODARCZYK, Intern

NORMAN GROSSBLATT, Senior Editor

ROSE MARIE MARTINEZ, Director,

Board on Population Health and Public Health Practice

CONSULTANTS

MIRIAM DAVIS, Independent Medical Writer,

Silver Spring, MD

ANNE STANGL,

Tulane School of Public Health and Tropical Medicine, New Orleans, LA

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×

REVIEWERS

This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following for their review of this report:

ARTHUR K. ASBURY, MD, Department of Neurology, University of Pennsylvania, Philadelphia, PA

SHARON COOPER, PhD, Professor and Chair, Department of Epidemiology and Biostatistics, Texas A & M University School of Rural Public Health, College Station, TX

PETER J. DYCK, MD, Director, Peripheral Nerve Research Laboratory, Mayo Clinic College of Medicine, Rochester, MN

DAVID GAYLOR, PhD, MS, President, Gaylor & Associates, LLC, Eureka Springs, AR

JACK M. GORMAN, MD, President and Psychiatrist in Chief, McLean Hospital, Belmont, MA

PHILIP GREENLAND, MD, Executive Associate Dean for Clinical and Translational Research, Northwestern University Feinberg School of Medicine, Chicago, IL

HOWARD KIPEN, MD, MPH, Director, Clinical Research and Occupational Medicine Division, Environmental & Occupational Health Sciences Institute, UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ

JOSEPH LADOU, MD, Editor, International Journal of Occupational and Environmental Health, Professor, Division of Occupational and Environmental Medicine, University of California, San Francisco, CA

ELLEN REMENCHIK, MD, MPH, Assistant Professor, Occupational and Environmental Medicine, The University of Texas Health Center, Tyler, TX

KATHERINE S. SQUIBB, PhD, Associate Professor & Head, Division of Environmental Epidemiology & Toxicology, University of Maryland School of Medicine, Baltimore, MD

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by David J. Tollerud, Professor and Chair, Department of Environmental and Occupational Health Sciences, University of Louisville and by Harold Sox, editor, Annals of Internal Medicine, American College of Physicians of Internal Medicine. Appointed by the National Research Council, Dr. Sox was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×

PREFACE

The 1990-1991 Persian Gulf War was brief and entailed few US casualties in comparison with other wars, and yet it had a profound impact on the lives of many of the troops. Among the 700,000 US military personnel deployed in the battle theater, many veterans have reported chronic symptoms and illnesses that they have attributed to their service in the gulf. Numerous studies have been conducted to characterize the long-term adverse health consequences of deployment to the Persian Gulf.

Potential exposures to numerous hazardous substances have been identified in association with the Gulf War. Most alarming are the smoke from oil-well fires that were set by Iraqis as they retreated at the end of the war and the potential exposures arising from the US military bombing of a poison-gas munitions dump at a location called Khamisiyah. Military personnel have also been reported to have had other exposures, such as to fuels, vaccines, pharmaceuticals, and pathogens. Most recently, the Department of Defense published a report documenting a large amount of pesticide use in the war theater. For most of those exposures, it is difficult or impossible to reconstruct doses because of lack of exposure measurements on either the individual or group level. The situation is compounded by the stress experienced by many veterans during deployment and in some cases after deployment. Stress is known to have serious acute and chronic health effects, but at the time of the Gulf War relatively little attention was given to reduction of stress and its consequences.

The Department of Veterans Affairs (VA) and the US Congress have secured the assistance of the Institute of Medicine (IOM) in evaluating the scientific literature regarding possible health outcomes associated with exposures that might have occurred in the Gulf War, IOM has published several volumes that review the clinical diseases that might be associated with exposures, such as exposure to sarin gas, depleted uranium, pesticides, solvents, rocket propellants, fuels, and combustion products. Such reviews continue and will provide information about illnesses related to exposure to pathogens, stress, and chemical agents. The congressional request regarding the possible association between illness and exposures in the gulf is similar to the approach Congress took after the Vietnam War to address the potential adverse health effects of exposure to Agent Orange.

The current report, however, takes a different approach, which is to identify the adverse health effects, if any, that are occurring among Gulf War veterans and thus might warrant further attention, either on the individual level or for the Gulf War veterans as a whole. Many of the relevant studies are limited by the lack of objective exposure information. Although there is a blood test that can provide an indication of exposure to Agent Orange and dioxin that occurred many years ago, there is not biological measure that can be employed today to assess exposures during the Gulf War. Another limitation is that most studies have relied on self-reports of symptoms and symptom-based case definitions to determine whether rates of diseases were increased among Gulf War veterans. Nonetheless, some studies do point to psychiatric disorders and neurologic end points that might be associated with Gulf War service and for which it might be possible to develop new approaches to prevention and clinical treatment that could benefit not only Gulf War veterans but also veterans of later conflicts. Our committee does not recommend

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×

that more such studies be undertaken for the Gulf War veterans, but, there would be value in continuing to monitor the veterans for some health end points, specifically, cancer, especially brain and testicular cancers, neurologic diseases including Amyotrophic Lateral Sclerosis (ALS), and causes of death. Therefore, despite the serious limitations of the available studies as a group, they do point the way to actions that might benefit Gulf War and other combat veterans.

I am deeply appreciative of the expert work of our committee members: Marcia Angell, W. Kent Anger, Michael Brauer, Dedra S. Buchwald, Francesca Dominici, Arthur L. Frank, Francine Laden, David Matchar, Samuel J. Potolicchio, Thomas G. Robins, George W. Rutherford, and Carol Tamminga. Although our committee developed conclusions independently of input from IOM and its staff, we deeply appreciate their hard work and attention to detail and the extensive research that they conducted to ensure that we had all the information that we needed from the outset. It has been a privilege and a pleasure to work with the IOM staff directed by Carolyn Fulco and with our consultant, Miriam Davis. Without them, this report would not have been possible. Most of all, our committee appreciates the veterans who served in the Gulf War and who have volunteered again and again to participate in the health studies that we reviewed. It is for them that we do this work. We hope this report will inform those who have given so much to our nation about what researchers have been able to learn about their health.


LYNN R. GOLDMAN, MD, MPH

PROFESSOR

JOHNS HOPKINS UNIVERSITY

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
   

 Exposure to Pyridostigmine Bromide

 

23

   

 Exposure to Depleted Uranium

 

24

   

 General Cohort Studies (Prevalence Studies)

 

25

   

 Studies Using Simulation to Assess the Potential Magnitude of Exposures

 

26

   

 Tent Heaters

 

26

   

 Khamisiyah Demolition and Potential Exposure to Sarin and Cyclosarin

 

26

   

 Epidemiologic Studies Using Fate and Transport Models to Assess Exposure to Sarin and Cyclosarin

 

35

   

 Studies Using Environmental Fate and Transport Models for Specific Exposures

 

37

   

 Studies Using Biologic Monitoring for Specific Exposures

 

39

   

 Depleted Uranium

 

39

   

 Oil-Well Fire Smoke

 

40

   

 Summary and Conclusions

 

41

   

 References

 

41

3

 

Considerations in Identifying and Evaluating the Literature

 

45

   

 Types of Epidemiologic Studies

 

45

   

 Cohort Studies

 

45

   

 Case-Control Studies

 

47

   

 Cross-Sectional Studies

 

47

   

 General Remarks

 

48

   

 Defining a New Syndrome

 

48

   

 Statistical Techniques Used to Develop a Case Definition

 

49

   

 Inclusion Criteria

 

51

   

 Additional Considerations

 

51

   

 Bias

 

52

   

 Confounding

 

52

   

 Chance

 

52

   

 Multiple Comparisons

 

52

   

 Assignment of Causality

 

53

   

 Limitations of Gulf War Veteran Studies

 

53

   

 Summary

 

53

   

 References

 

54

4

 

Major Cohort Studies

 

55

   

 General Limitations of Gulf War Cohort Studies and Derivative Studies

 

56

   

 Organization of This Chapter

 

58

   

 Population-Based Studies

 

58

   

 The Iowa Study

 

58

   

 Department of Veterans Affairs Study

 

60

   

 Oregon and Washington Veteran Studies

 

63

   

 Kansas Veteran Study

 

64

   

 Canadian Veteran Study

 

65

   

 United Kingdom Veteran Studies

 

65

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
   

 Danish Peacekeeper Studies

 

68

   

 Australian Veteran Studies

 

69

   

 Military-Unit-Based Studies

 

70

   

 Ft. Devens and New Orleans Cohort Studies

 

70

   

 Seabee Reserve Battalion Studies

 

71

   

 Larger Seabee Cohort Studies

 

73

   

 Pennsylvania Air National Guard Study

 

74

   

 Other Cohort Studies

 

75

   

 Hawaii and Pennsylvania Active Duty and Reserve Study

 

76

   

 New Orleans Reservist Studies

 

76

   

 Air Force Women Study

 

76

   

 Connecticut National Guard

 

77

   

 References

 

105

5

 

Health Outcomes

 

115

   

 Cancer (ICD-10 C00-D48)

 

115

   

 Primary and Secondary Studies

 

116

   

 Summary and Conclusion

 

118

   

 Mental and Behavioral Disorders (ICD-10 F00-F99)

 

122

   

 Primary Studies

 

123

   

 Secondary Studies

 

127

   

 Summary and Conclusion

 

127

   

 Neurobehavioral and Neurocognitive Outcomes (ICD-10 F00-F99)

 

131

   

 Neurobehavioral Tests and Confounding Factors

 

131

   

 Studies That Respond to Question 1 (Outcomes in Gulf War-Deployed Veterans vs Veterans Deployed Elsewhere or Not Deployed)

 

132

   

 Studies That Respond to Question 2 (Symptomatic vs Nonsymptomatic Veterans)

 

135

   

 Related Findings: Malingering and Association of Symptoms with Objective Test Results

 

140

   

 Summary and Conclusion

 

140

   

 Diseases of the Nervous System (ICD-10 G00-G99)

 

153

   

 Amyotrophic Lateral Sclerosis

 

153

   

 Summary and Conclusion

 

155

   

 Peripheral Neuropathy and Other Neurologic Outcomes

 

157

   

 Summary and Conclusion

 

159

   

 Chronic Fatigue Syndrome

 

161

   

 Primary Studies

 

162

   

 Secondary Studies

 

162

   

 Summary and Conclusion

 

163

   

 Diseases of the Circulatory System (ICD-10 I00-I99)

 

166

   

 Primary Studies

 

166

   

 Secondary Studies

 

167

   

 Summary and Conclusion

 

168

   

 Diseases of the Respiratory System (ICD-10 J00-J99)

 

170

   

 Associations of Respiratory Outcomes with Deployment in the Gulf War Theater

 

170

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
   

 Associations of Respiratory Outcomes with Specific Exposures Experienced by Gulf War Veterans During Their Deployment

 

172

   

 Summary and Conclusion

 

174

   

 Diseases of the Digestive System (ICD-10 K00-K93)

 

180

   

 Primary Studies

 

180

   

 Secondary Studies

 

181

   

 Summary and Conclusion

 

181

   

 Diseases of the Skin and Subcutaneous Tissue (ICD-10 L00-L99)

 

183

   

 Primary Studies

 

183

   

 Secondary Studies

 

183

   

 Summary and Conclusion

 

183

   

 Diseases of the Musculoskeletal System and Connective Tissue (ICD-10 M00-M99)

 

185

   

 Arthritis and Arthralgia

 

185

   

 Summary and Conclusion

 

186

   

 Fibromyalgia

 

188

   

 Primary Studies

 

188

   

 Secondary Studies

 

189

   

 Summary and Conclusion

 

190

   

 Birth Defects and Adverse Pregnancy Outcomes (ICD-10 O00-Q99)

 

192

   

 Birth Defects

 

192

   

 Summary and Conclusion

 

194

   

 Adverse Pregnancy Outcomes

 

195

   

 Summary and Conclusion

 

195

   

 Male Fertility Problems and Infertility

 

196

   

 Symptoms, Signs, and Abnormal Clinical and Laboratory Findings (ICD-10 R00-R99)

 

202

   

 Unexplained Illness

 

202

   

 Hospitalizations for Unexplained Illness

 

202

   

 Factor-Analysis Derived Syndromes

 

203

   

 Cluster Analysis

 

212

   

 Summary and Conclusion

 

213

   

 Injury and External Causes of Morbidity and Mortality (ICD-10 S00-Y98)

 

219

   

 Primary Studies

 

219

   

 Secondary Studies

 

220

   

 Summary and Conclusion

 

220

   

 All-Cause Hospitalization Studies

 

223

   

 Primary Studies

 

223

   

 Summary and Conclusion

 

224

   

 Multiple Chemical Sensitivity

 

227

   

 Primary Studies

 

227

   

 Secondary Studies

 

228

   

 Summary and Conclusion

 

229

   

 References

 

232

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R1
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R2
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R3
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R4
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R5
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R6
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R8
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R9
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R10
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R11
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R13
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R14
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R15
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/11729.
×
Page R16
Next: Summary »
Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War Get This Book
×
Buy Hardback | $59.00 Buy Ebook | $47.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

In 1998, in response to the growing concerns that many returning Gulf War veterans began reporting numerous health problems that they believed to be associated with their service in the Persian Gulf, Congress passed two laws which directed the Secretary of Veterans Affairs to enter into a contract with the National Academy of Sciences. They were tasked to review and evaluate the scientific and medical literature regarding associations between illness and exposure to toxic agents, environmental or wartime hazards, and preventive medicines or vaccines associated with Gulf War service. In addition, the Institute of Medicine of the National Academy of Sciences provided conclusions to these studies that were considered when making decisions about compensation to veterans.

Gulf War and Health Volume 4: Health Effects of Serving in the Gulf War summarizes in one place the current status of health effects in veterans deployed to the Persian Gulf irrespective of exposure information. This book reviews, evaluates, and summarizes both peer-reviewed scientific and medical literature addressing the health status of Gulf War veterans.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!