• 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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