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Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature
Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature
Committee on the Review of the Scientific Literature on Amyotrophic Lateral Sclerosis in Veterans
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
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Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature
THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W. 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-1637, Task Order 25 and Task Order 30, between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, or conclusions 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: 0-309-10254-5
International Standard Book Number-13: 978-0-309-10254-4
Additional copies of this report are available from the
National Academies Press,
500 Fifth Street, N.W., 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.
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Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature
“Knowing is not enough; we apply,
Willing is not we do.”
—Goethe
INSTITUTE MEDICINE OF OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
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Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, 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
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Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature
COMMITTEE ON THE REVIEW OF THE SCIENTIFIC LITERATURE ON AMYOTROPHIC LATERAL SCLEROSIS IN VETERANS
RICHARD T.JOHNSON, MD (Chair), Distinguished Service Professor of Neurology, Microbiology, and Neuroscience,
Johns Hopkins University School of Medicine, Baltimore, MD
WALTER G.BRADLEY, DM, FRCP, Professor and Chair,
Department of Neurology, Miller School of Medicine at the University of Miami, FL
BEATE R.RITZ, MD, PhD, MPH, Professor and Vice Chair,
Department of Epidemiology, University of California, Los Angeles School of Public Health, Los Angeles
WALTER A.ROCCA, MD, MPH, Professor of Epidemiology and Neurology,
Mayo Clinic College of Medicine, Rochester, MN
JEREMY M.SHEFNER, MD, PhD, Professor and Chair,
Department of Neurology, State University of New York, Upstate Medical University, Syracuse
CHRISTINA WOLFSON, PhD, Professor of Epidemiology and Biostatistics,
McGill University, Montreal, Canada
STAFF
ABIGAIL MITCHELL, PhD, Senior Program Officer
MICHAEL SCHNEIDER, MPH, Senior Program Associate
DEEPALI PATEL, Senior Program Associate
PETER JAMES, Research Associate
DAMIKA WEBB, Research Assistant
RENEE WLODARCZYK, Program Assistant
NORMAN GROSSBLATT, Senior Editor
ROSE MARIE MARTINEZ, ScD, Director,
Board on Population Health and Public Health Practice
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Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature
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 of 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:
CARMEL ARMON, MD, MSC, MHS, Tufts University and Baystate Medical Center, Boston, MA
CARLO DELUCA, PHD, Neuromuscular Research Center, Boston University, MA
LAWRENCE GOLDSTEIN, PHD, Department of Cellular and Molecular Medicine, University of California, San Diego and Howard Hughes Medical Institute
CLIFTON L.GOOCH, MD, EMG Laboratory of New York Presbyterian Hospital and Columbia Neuropathy Research Center, Columbia University College of Physicians and Surgeons, NY
FREYA KAMEL, MD, MPH, National Institute of Environmental Health Sciences, Research Triangle Park, NC
LORENE NELSON, PHD, Department of Health Research and Policy, Stanford University, CA
M.DONALD WHORTON, MD, MPH, Executive Vice President and Epidemiologist, WorkCare, Inc., Alameda, CA
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 Elena Nightingale, Scholar-in-Residence, Institute of Medicine. Appointed by the National Research Council, she 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 author committee and the institution.
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Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature
CONTENTS
Summary
1
Methodology
2
Conclusion
3
Recommendations
4
1
Introduction
7
The Department of Veterans Affairs Request for This Study and the Statement of Task
8
Previous Institute of Medicine Work on Veterans’ Issues
9
The Committee’s Approach to Its Charge
10
Categories of Association
11
Origin and Evolution of the Categories
11
Sufficient Evidence of a Causal Relationship
12
Sufficient Evidence of an Association
12
Limited and Suggestive Evidence of an Association
12
Inadequate or Insufficient Evidence to Determine Whether an Association Exists
13
Limited and Suggestive Evidence of No Association
13
Organization of the Report
13
References
13
2
Evidence Regarding Amyotrophic Lateral Sclerosis in Veterans
19
Studies on Amyotrophic Lateral Sclerosis in the Veteran Population
19
Smith et al. 2000
26
Kang and Bullman 2001
27
Haley 2003
28
Horner et al. 2003 and Coffman et al. 2005
29
Weisskopf et al. 2005
32
Conclusion
34
References
35
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Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature
3
Recommendations
37
Recommendation 1: Use Data from Other Epidemiologic Studies
37
Recommendation 2: In-Depth Analysis of Existing Risk-Factor Studies
39
Recommendation 3: Conduct Additional Epidemiologic Studies of the Association Between Military Service and Amyotrophic Lateral Sclerosis
40
References
41
A
Examples of Risk Factors Possibly Relevant to Military Service
43
Physical Activity
43
Cigarette-Smoking and Alcohol Consumption
44
Trauma
45
Transmissible Agents
46
Lead
47
Pesticides
48
Environmental Toxicants
48
References
48
B
Possible Conceptual Models Linking Military Service and Amyotrophic Lateral Sclerosis
53
