NATIONAL ACADEMY PRESS
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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 project was supported by Contract No. DASW01-97-C-0078 between the National Academy of Sciences and the Department of Defense. 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.
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THE NATIONAL ACADEMIES
National Academy of Sciences
National Academy of Engineering
Institute of Medicine
National Research Council
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. Bruce M. Alberts 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. William 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. Kenneth I. Shine 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. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.
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PRINCIPAL INVESTIGATOR
Lorenz Rhomberg,
Gradient Corporation, Cambridge, Massachusetts (formerly of Harvard School of Public Health, Boston, Massachusetts)
ADVISORY GROUP
Arthur J. Barsky,
Brigham and Women's Hospital, Boston, Massachusetts
Germaine M. Buck,
State University of New York at Buffalo, Buffalo, New York
William S. Cain,
University of California, San Diego, California
John Doull,
The University of Kansas Medical Center, Kansas City, Kansas
Ernest Hodgson,
North Carolina State University, Raleigh, North Carolina
David H. Moore,
Battelle Memorial Institute, Bel Air, Maryland
Roy Reuter,
Life Systems, Inc., Cleveland, Ohio
Ken W. Sexton,
University of Minnesota, Minneapolis, Minnesota
Robert E. Shope,
University of Texas, Medical Branch, Galveston, Texas
Ainsley Weston,
National Institute of Occupational Safety and Health, Morgantown, West Virginia
Staff
Carol A. Maczka, Project Director
Raymond A. Wassel, Program Director
Susan N.J. Pang, Program Officer
Robert J. Crossgrove, Editor
Norman Grossblatt, Editor
Catherine M. Kubik, Senior Project Assistant
Leah L. Probst, Project Assistant
Mirsada Karalic-Loncarevic, Information Specialist
Sponsor
U.S. Department of Defense
BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY
Gordon Orians (Chair),
University of Washington, Seattle, Washington
Donald Mattison (Vice Chair),
March of Dimes, White Plains, New York
David Allen,
University of Texas, Austin, Texas
Ingrid C. Burke,
Colorado State University, Fort Collins, Colorado
William L. Chameides,
Georgia Institute of Technology, Atlanta, Georgia
John Doull,
The University of Kansas Medical Center, Kansas City, Kansas
Christopher B. Field,
Carnegie Institute of Washington, Stanford, California
John Gerhart,
University of California, Berkeley, California
J. Paul Gilman,
Celera Genomics, Rockville, Maryland
Bruce D. Hammock,
University of California, Davis, California
Mark Harwell,
University of Miami, Miami, Florida
Rogene Henderson,
Lovelace Respiratory Research Institute, Albuquerque, New Mexico
Carol Henry,
Chemical Manufacturers Association, Arlington, Virginia
Barbara Hulka,
University of North Carolina, Chapel Hill, North Carolina
James F. Kitchell,
University of Wisconsin, Madison, Wisconsin
Daniel Krewski,
University of Ottawa, Ottawa, Ontario
James A. MacMahon,
Utah State University, Logan, Utah
Mario J. Molina,
Massachusetts Institute of Technology, Cambridge, Massachusetts
Charles O'Melia,
Johns Hopkins University, Baltimore, Maryland
Willem F. Passchier,
Health Council of the Netherlands
Kirk Smith,
University of California, Berkeley, California
Margaret Strand,
Oppenheimer Wolff Donnelly & Bayh, LLP, Washington, D.C.
Terry F. Yosie,
Chemical Manufacturers Association, Arlington, Virginia
Senior Staff
James J. Reisa, Director
David J. Policansky, Associate Director and Senior Program Director for Applied Ecology
Carol A. Maczka, Senior Program Director for Toxicology and Risk Assessment
Raymond A. Wassel, Senior Program Director for Environmental Sciences and Engineering
Kulbir S. Bakshi, Program Director for the Committee on Toxicology
Lee R. Paulson, Program Director for Resource Management
COMMISSION ON LIFE SCIENCES
Michael T. Clegg (Chair),
University of California, Riverside, California
Paul Berg (Vice Chair),
Stanford University, Stanford, California
Frederick R. Anderson,
Cadwalader, Wickersham & Taft, Washington, D.C.
Joanna Burger,
Rutgers University, Piscataway, New Jersey
James E. Cleaver,
University of California, San Francisco, California
David Eisenberg,
University of California, Los Angeles, California
John Emmerson,
Fishers, Indiana
Neal First,
University of Wisconsin, Madison, Wisconsin
David J. Galas,
Keck Graduate Institute of Applied Life Science, Claremont, California
David V. Goeddel,
Tularik, Inc., South San Francisco, California
Arturo Gomez-Pompa,
University of California, Riverside, California
Corey S. Goodman,
University of California, Berkeley, California
Jon W. Gordon,
Mount Sinai School of Medicine, New York, New York
David G. Hoel,
Medical University of South Carolina, Charleston, South Carolina
Barbara S. Hulka,
University of North Carolina, Chapel Hill, North Carolina
Cynthia Kenyon,
University of California, San Francisco, California
Bruce R. Levin,
Emory University, Atlanta, Georgia
David Livingston,
Dana-Farber Cancer Institute, Boston, Massachusetts
Donald R. Mattison,
March of Dimes, White Plains, New York
Elliot M. Meyerowitz,
California Institute of Technology, Pasadena, California
Robert T. Paine,
University of Washington, Seattle, Washington
Ronald R. Sederoff,
North Carolina State University, Raleigh, North Carolina
Robert R. Sokal,
State University of New York, Stony Brook, New York
Charles F. Stevens,
The Salk Institute, La Jolla, California
Shirley M. Tilghman,
Princeton University, Princeton, New Jersey
Raymond L. White,
University of Utah, Salt Lake City, Utah
Staff
Warren R. Muir, Executive Director
Jacqueline K. Prince, Financial Officer
Barbara B. Smith, Administrative Associate
Kit W. Lee, Administrative Assistant
OTHER REPORTS OF THE BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY
Waste Incineration and Public Health (1999)
Hormonally Active Agents in the Environment (1999)
Research Priorities for Airborne Particulate Matter: II. Evaluating Research Progress and Updating the Portfolio (1999)
Ozone-Forming Potential of Reformulated Gasoline (1999)
Risk-Based Waste Classification in California (1999)
Arsenic in Drinking Water (1999)
Research Priorities for Airborne Particulate Matter: I. Immediate Priorities and a Long-Range Research Portfolio (1998)
Brucellosis in the Greater Yellowstone Area (1998)
The National Research Council's Committee on Toxicology: The First 50 Years (1997)
Toxicologic Assessment of the Army's Zinc Cadmium Sulfide Dispersion Tests (1997)
Carcinogens and Anticarcinogens in the Human Diet (1996)
Upstream: Salmon and Society in the Pacific Northwest (1996)
Science and the Endangered Species Act (1995)
Wetlands: Characteristics and Boundaries (1995)
Biologic Markers (5 reports, 1989–1995)
Review of EPA's Environmental Monitoring and Assessment Program (3 reports, 1994–1995)
Science and Judgment in Risk Assessment (1994)
Ranking Hazardous Waste Sites for Remedial Action (1994)
Pesticides in the Diets of Infants and Children (1993)
Issues in Risk Assessment (1993)
Setting Priorities for Land Conservation (1993)
Protecting Visibility in National Parks and Wilderness Areas (1993)
Dolphins and the Tuna Industry (1992)
Hazardous Materials on the Public Lands (1992)
Science and the National Parks (1992)
Animals as Sentinels of Environmental Health Hazards (1991)
Assessment of the U.S. Outer Continental Shelf Environmental Studies Program, Volumes I–IV (1991–1993)
Human Exposure Assessment for Airborne Pollutants (1991)
Monitoring Human Tissues for Toxic Substances (1991)
Rethinking the Ozone Problem in Urban and Regional Air Pollution (1991)
Decline of the Sea Turtles (1990)
Copies of these reports may be ordered from the National Academy Press
(800) 624-6242
(202) 334-3313
Preface
Illnesses possibly associated with U.S. military deployments during Operations Desert Storm and Desert Shield (1990–1991) have been the subject of much debate and national attention. In order to help prevent and reduce the number of illnesses in future deployments, the Department of Defense (DOD) requested that the National Academy of Sciences (NAS) develop a long-term strategy for protecting the health of the nation's military personnel when deployed to unfamiliar environments. As part of the academy's response to this request, I was asked to develop an analytical framework for assessing risks to deployed forces from a variety of health threats encountered during deployments. A group of advisers was convened to assist me with the project, providing me with advice in their various areas of expertise and guiding the development of the framework. I am very appreciative of the valuable input they provided.
As part of the information gathering for this study, DOD personnel provided very useful presentations on relevant DOD programs. I wish to acknowledge in particular COL Francis O'Donnell (Office of the Special Assistant for Gulf War Illness), Jack Heller (U.S. Army Center for Health Promotion and Preventive Medicine), John Resta (U.S. Army Center for Health Promotion and Preventive Medicine), Hank Gardner (U.S. Army Center for Environmental Health Research), MAJ Larry Kimm (Joint Staff), CDR Paul Knechtges (U.S. Army Center for Environmental Health Research), and Thomas Burke (Johns Hopkins University). These briefings were especially helpful because I was chosen for this project expressly as a person without extensive experience in military matters and am not well versed in military organization structure, operations, policy, or doc-
trine. Since DOD's aim was specifically to obtain an independent assessment of how the military can protect their deployed personnel in the future, I hope my newness to these matters can lead to some benefit in freshness of point of view that will offset the lack of extensive experience into the military's current extensive activities and programs.
Special thanks are owed to the six authors who were commissioned to write papers on topics that needed more in-depth analysis. Morton Lippmann (New York University School of Medicine) discussed approaches for collecting and using personal exposure and biological-marker information for assessing health risks; Edward Martin (Edward Martin and Associates, Inc.) characterized possible scenarios of future deployments and battle considerations; Joseph Rodricks (The Life Sciences Consultancy) reviewed traditional risk assessment methods and how risk assessment in general might be applied to deployment scenarios; Joan Rose (University of South Florida) addressed health assessment and risk management integration for biological agents; Karl Rozman (University of Kansas Medical Center) proposed a new paradigm for incorporating toxicokinetic information in risk assessment; and Raymond Yang (Colorado State University) discussed toxicologic interactions among harmful agents. These authoritative papers were presented at a workshop on January 28–29, 1999 in Washington, DC, and have been published concurrently with this report (see Workshop Proceedings on Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces).
This report has been reviewed in draft form by individuals chosen for their technical expertise and diverse perspectives in accordance with procedures approved by the NRC's Report Review Committee for reviewing NRC and Institute of Medicine reports. The purpose of that independent review was to provide candid and critical comments to assist the NRC 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 review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. I wish to thank the following individuals, who are neither officials nor employees of the NRC, for their participation in the review of this report: John C. Bailar, III, University of Chicago; Thomas A. Burke, Johns Hopkins University; Steven D. Colome, Irvine, California; John L. Emmerson, Fishers, Indiana; Bernard D. Goldstein, Rutgers University; Rogene F. Henderson, Lovelace Respiratory Research Institute; Peter Hidalgo, Waverly Hall, Georgia; Paul Knechtges, Sherikon, Inc.; Matthew S. Meselson, Harvard University; and Arthur C. Upton, Rutgers University.
The individuals listed above, as well as the advisers for this project,
have provided many constructive comments and suggestions. It must be emphasized, however, that responsibility for the final content of this report rests entirely with the principal investigator and the NRC.
I would also like to acknowledge the principal investigators of the three sister projects that were conducted concurrently with this one. Thomas McKone (University of California, Berkeley) was the principal investigator of a project that considered technology and methods for detection and tracking of exposures to a subset of harmful agents; Michael Kleinman (University of California, Irvine) and Michael Wartell (Indiana University—Purdue University Fort Wayne) were co-investigators of a project that reviewed and evaluated approaches and technologies used in the development and evaluation of equipment and clothing for physical protection and decontamination; and Samuel Guze (Washington University) and Phillip Russell were co-investigators who reviewed and evaluated medical protection, health consequences management and treatment, and medical record keeping.
My personal thanks are also owed to the NRC staff who were involved in this project. In particular, Carol A. Maczka and Raymond A. Wassel expertly brought structure to the project and guided the interactions among DOD briefers, the advisory committee, and the commissioned authors along productive lines. Susan N.J. Pang provided essential technical help, especially in obtaining documentation and preparing material. Other staff members who contributed to this effort are James J. Reisa, Robert J. Crossgrove, Catherine M. Kubik, and Leah L. Probst.
LORENZ RHOMBERG
PRINCIPAL INVESTIGATOR
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