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6 Conclusion Numerous investigations and research efforts have been undertaken because of concern about the impact of the Gulf War on the health of U.S. troops who served in that conflict. Some of these efforts have addressed the federal government's preparedness to meet its obligations and responsibilities to protect U.S. military service members, veterans, and their families. Others have attempted to determine what health effects might be attributed to service in the Gulf War. Still others have tried to identify possible causes for the myriad reports of health problems among Gulf War veterans. The continuing focus on the health problems of Gulf War veterans is attributable in no small part to the efforts of individual veterans and the organizations that represent them. These veterans have tirelessly kept before the public and the Congress the idea that more needs to be done to help those veterans who are experiencing health problems they believe are due to their service in the Gulf War. Although the adequacy of the government's response has been criticized, the Departments of Veterans Affairs (VA), Defense (DoD), and Health and Human Services (HHS) have expended enormous effort and resources in attempts to address a number of important issues related to the health of Gulf War veterans. VA and DoD have implemented clinical diagnostic programs in which more than 100,000 Gulf War veterans have participated. They have funded more than 120 distinct research projects on Gulf War veterans' illnesses, covering the following areas of research: prevalence of and risk factors for symptoms and alterations in general health status, brain and nervous system function, reproductive health,
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immune function, mortality experience, environmental toxicology, chemical weapons, depleted uranium, pyridostigmine bromide, leishmaniasis, interactions of exposures, prevention of diseases and illnesses, diagnosis of conditions related to Gulf War service, and treatment of conditions related to Gulf War service. The findings of these efforts have contributed valuable information to our attempts to understand the causes and consequences of Gulf War veterans' illnesses, yet fundamental questions remain. We do not know the extent to which the population of Gulf War veterans is experiencing health problems that they believe are related to service in the Gulf, nor do we know whether the health status of the Gulf War population is better than, worse than, or the same as that of veterans who were not deployed to the Gulf War. Additionally, there has been no systematic evaluation of whether the health status of these veterans is changing and, if so, how. The committee has developed and recommends implementation of a research portfolio and prospective cohort study—the Gulf War Veterans' Health Study (GWVHS)—that it believes will address these questions. Key to this portfolio is the linking of individual studies through the collection of a core set of key data elements on health and its correlates. Such linkage will enhance the contributions of future studies by providing a mechanism that allows for comparisons across all research undertaken. The committee believes that the GWVHS and the broad research portfolio will, if implemented, lead to a greater understanding of the longer-term health effects of service in the Gulf War. The issues surrounding the health of Gulf War veterans are complex, from both a scientific and a policy perspective. Many believe, correctly or not, that attempts to address these issues have been governed by people with conflicting interests. As long as that view persists, resolving these issues will be difficult. The committee recommends establishing an independent advisory board to oversee the implementation of the GWVHS and accompanying research portfolio to assure the public, the veterans, Congress, the scientific community, and others that all efforts to resolve these issues are being conducted according to the highest standards of scientific integrity and public accountability. In the more than 8 years since the men and women who served in the Gulf War returned home, many veterans have become ill and believe that their health problems are a consequence of participation in the Gulf War. A schism has developed, with ill veterans and their representatives on one side and the federal agencies charged with addressing veterans' health problems on the other. In the
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interests of all involved, additional coordinated and concerted efforts must be made to bridge this gap. The committee believes that the recommendations in this report will facilitate that process and urges that they be implemented as speedily as possible.
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