Measuring the Health of Persian Gulf Veterans: Workshop Summary

Committee on Measuring the Health of Persian Gulf Veterans

Division of Health Promotion and Disease Prevention

Institute Of Medicine

NATIONAL ACADEMY PRESS
Washington, D.C.
1998



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--> Measuring the Health of Persian Gulf Veterans: Workshop Summary Committee on Measuring the Health of Persian Gulf Veterans Division of Health Promotion and Disease Prevention Institute Of Medicine NATIONAL ACADEMY PRESS Washington, D.C. 1998

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--> NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 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. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this study was provided by the Departments of Defense (contract no. DASW01-98-K-0002) and Veterans Affairs (contract no. V101(93)P-1580). The views presented are those of the Institute of Medicine Committee on Measuring the Health of Persian Gulf Veterans and are not necessarily those of the funding organization. International Standard Book Number 0-309-06245-4 This summary is available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington Metropolitan area), or visit the NAP’s on-line bookstore at http://www.nap.edu. For more information about the Division of Health Promotion and Disease Prevention, visit our homepage at: www2.nas.edu/hpdp. Copyright 1998 by the Institute of Medicine. 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 image adopted as a logo-type by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemusseen in Berlin.

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--> COMMITTEE ON MEASURING THE HEALTH OF PERSIAN GULF VETERANS Dan Blazer, II, M.D., Ph.D., M.P.H.,* (Cochair) Dean of Medical Education and Professor of Psychiatry and Community and Family Medicine, Office of the Dean, Duke University Medical Center Isabel V. Hoverman, M.D., (Cochair) Austin Internal Medicine Associates, L.L.P., Austin, TX, and Clinical Assistant Professor of Medicine, University of Texas Medical Branch, Galveston Martha C. Beattie, Ph.D., Alcohol Research Group, Public Health Institute, Berkeley, CA Pennifer Erickson, Ph.D., State College, PA Nelson Gantz, M.D., Chairman, Department of Medicine, and Chief, Division of Infectious Diseases, Pinnacle Health Hospitals, Harrisburg, PA; and Clinical Professor of Medicine, Allegheny University of the Health Sciences Richard M. Garfield, Dr. P.H., Bendixen Professor of Clinical International Nursing, Columbia University William Golden, M.D., Director, Division of General Internal Medicine, University of Arkansas for the Medical Sciences Kathleen N. Lohr, Ph.D., Director, Health Services and Policy Research, Research Triangle Institute, Research Triangle Park, NC David Nerenz, Ph.D., Director, Center for Health System Studies, Henry Ford Health System, Detroit Donald L. Patrick, Ph.D., M.S.P.H.,* Professor, Department of Health Services, School of Public Health and Community Medicine, University of Washington Robert O. Valdez, Ph.D., Professor, Health Policy and Management, UCLA School of Public Health Board on Health Promotion and Disease Prevention Liaison Robert B. Wallace, M.D., Professor of Preventive and Internal Medicine, Department of Preventive Medicine, University of Iowa Staff Lyla M. Hernandez, M.P.H., Study Director Patricia J. Spaulding, Project Assistant/Research Assistant Kathleen R. Stratton, Ph.D., Director, Division of Health Promotion and Disease Prevention Donna D. Duncan, Division Assistant *   Member, Institute of Medicine.

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--> Acknowledgments The committee wishes to express its appreciation to the workshop presenters for providing an excellent overview of the health concerns of Persian Gulf veterans and of research efforts aimed at better understanding these concerns. The presenters were: David Cowan, Nancy Dalager, COL John T. Graham, CAPT Gregory Gray, LTC Charles Engle, COL Bruce Jones, Han K. Kang, Mark Meterko, Frances M. Murphy, LTC Mark Rubertone, and David A. Schwartz. The committee would also like to thank Mr. Albert Donnay who, during the open testimony session of the workshop, provided his view of this topic. Michael Hayes deserves thanks for his pertinent and helpful editorial comments. This report has been reviewed by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the authors and the IOM in making the 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 contents of the review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report: Arthur K. Asbury, M.D., Hospital of the University of Pennsylvania, Philadelphia, Pa.; Margit L. Bleecker, M.D., PhD, Center for Occupational and Environmental Neurology, Baltimore, M.D..; Gerard Burrow, M.D., Yale University School of Medicine; Karl T. Kelsey, M.D., M.P.H., Harvard School of Public Health; David P. Rall, M.D., Ph.D., Washington, D.C.; and Robert B. Wallace, M.D., University of Iowa. Although the individuals listed above have provided many constructive comments and suggestions, responsibility for the final content of this report rests solely with the authoring committee and the IOM.

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--> Contents 1   Introduction   1 2   Background   3 3   Workshop Presentations   5     DVA and DoD Diagnostic Programs for Evaluating Health Problems of Persian Gulf Veterans   5     Descriptive Statistics   6     Population and Survey Sample Research   11     Gulf War Research in the United Kingdom   19     Databases   21     The Health of Patients in the Specialized Care Program   23     Draft Protocol   24     Open Testimony   25 4   Conclusion   27     References   29     Appendix: Workshop on Measuring the Health of Persian Gulf Veterans   31

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