3
Findings

In preparing to assist in developing a plan for establishing a national center (or centers) for the study of war-related illnesses and postdeployment health issues, the committee reviewed and analyzed the background information received. From this analysis emerged a number of findings that guided the committee in developing its recommendations.

  • Extensive research exists on the health of veterans of military conflict.

Both the DoD and VA have spent millions of dollars on research related to military deployment. A rich literature exists on the adverse health effects of military conflicts, including World War II, Korea, and Vietnam. Most recently, the DoD and VA have funded more than 120 distinct research projects on Gulf War veterans' illnesses, focusing on such topics as prevalence of and risk factors for symptoms and alterations in general health status, brain and nervous system function, reproductive health, immune function, mortality, environmental toxicology, chemical weapons, depleted uranium, pyridostigmine bromide, leishmaniasis, interactions of exposures, and prevention of diseases and illnesses (Research Working Group, 1998).

  • The definition of deployment-related health issues selected for research has been too narrowly focused and has excluded some health consequences related to deployment.

The definition of war-related illnesses and postdeployment health issues must include a broad construct. Most current research, however, is limited to the



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National Center for Military Deployment Health Research 3 Findings In preparing to assist in developing a plan for establishing a national center (or centers) for the study of war-related illnesses and postdeployment health issues, the committee reviewed and analyzed the background information received. From this analysis emerged a number of findings that guided the committee in developing its recommendations. Extensive research exists on the health of veterans of military conflict. Both the DoD and VA have spent millions of dollars on research related to military deployment. A rich literature exists on the adverse health effects of military conflicts, including World War II, Korea, and Vietnam. Most recently, the DoD and VA have funded more than 120 distinct research projects on Gulf War veterans' illnesses, focusing on such topics as prevalence of and risk factors for symptoms and alterations in general health status, brain and nervous system function, reproductive health, immune function, mortality, environmental toxicology, chemical weapons, depleted uranium, pyridostigmine bromide, leishmaniasis, interactions of exposures, and prevention of diseases and illnesses (Research Working Group, 1998). The definition of deployment-related health issues selected for research has been too narrowly focused and has excluded some health consequences related to deployment. The definition of war-related illnesses and postdeployment health issues must include a broad construct. Most current research, however, is limited to the

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National Center for Military Deployment Health Research traditional considerations of such things as acute illnesses and injuries resulting from combat, training, infectious diseases, and environmental exposures. Issues that fall within the construct of deployment health research Should include: diagnosable conditions; medically unexplained symptoms (both physical and mental); effects on health-related quality of life (e.g., death and duration of life, impairment, physical and mental functional status, health perceptions, and opportunity [the capacity for health, the ability to withstand stress, and physiologic reserves]); family impacts; and sequelae of combat injuries. Such issues may arise prior to, during, or following deployment. The focus of research efforts, then, should encompass this broadened definition of deployment health. There are gaps in the emerging data relevant to the study of war-related illnesses and postdeployment health issues. Data generated by the DoD primarily relate to active-duty soldiers. Information regarding their health tends to focus on acute effects of war-related illnesses. Many deployed personnel in today's military, however, may be activated from reserve units that are deployed, then separated soon after return from conflict. The VA, on the other hand, concentrates on the health of those individuals no longer on active-duty, and this frequently includes older veterans. There are significant gaps in knowledge, both in the focus of research by the DoD and VA as well as in the delivery of services from postdeployment to later in life. Many investigations of health issues and effects of deployment have been mounted in response to health problems after they occurred, rather than being undertaken proactively. A review of previous research led the committee to conclude that research has been aimed at attempting to solve identified problems, such as the health effects of mustard gas in WWII testing, and of Agent Orange in Vietnam, as well as the medically unexplained health problems of individuals deployed to the Gulf War. Such research efforts increased as complaints from the veterans' community, the Congress, and the general public increased, yet research still lagged far behind efforts to provide care. Research efforts only recently have begun to focus on a broader, more proactive research agenda. The committee was impressed with the newly broadened focus of research into war-related illnesses and postdeployment health issues. As with all research, the quality of the studies varies. Many excellent efforts have been fielded and the findings reported in prestigious biomedical journals. These research efforts have in large part, however, not been undertaken in response to a well-developed and coordinated research agenda. Further, coordination of research efforts and strategies, as well as communication of findings, has been limited.

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National Center for Military Deployment Health Research Many veterans and some congressional staff are skeptical of the objectivity of both the DoD and VA in the conduct of research into deployment-related health issues. Veterans have emphasized the perceived lack of credibility of both these agencies, despite the tremendous research and treatment efforts they have undertaken. One reason for this credibility gap may be the previous actions of DoD and VA in addressing military health issues of prior conflicts, such as health effects of herbicides in Vietnam. Additionally, the VA is perceived as having a conflict of interest between its role as payor of disability benefits for veterans found to have war-related illnesses and its role as researcher into war-related illnesses. Distrust of the DoD was exacerbated when it notified 100,000 veterans of the Gulf War that they may have been exposed to chemical warfare agents destroyed at Khamisiyah, after the department had made repeated assurances that no such exposures had occurred. Concerns such as these encouraged the committee to structure a national center, such that oversight of its efforts would include representatives of the VA and DoD, while ensuring that the center would be as independent as possible from direct control by these agencies. None of the locations of existing or proposed centers provides an adequate model for a national center that not only must be responsible for the conduct of a broad range of research but also must provide for synthesis and coordination of existing research efforts and for proposing policy changes based on research findings. Models of a national center or centers were discussed in Chapter 2. Additionally, the committee considered the possibility of placing a national center in the National Institutes of Health, in the Centers for Disease Control and Prevention, or within a university setting. Advantages and disadvantages of these settings were analyzed, and the strengths and limitations of each are displayed in Table 3.1 below. The committee also considered dividing the center between two federal departments (e.g., DoD and VA) but determined that this option would not fulfill the goals of a national center. Further elaboration of this analysis appears in Chapter 4. Examples exist of centers that cut across agencies and groups to carry out effective research agendas. The committee found the newly established Military and Veterans Health Coordinating Board the best option for consideration as a site for the conduct of the tasks that might be envisioned for a national center (or centers) for the study of war-related illnesses and postdeployment health issues.

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National Center for Military Deployment Health Research This chapter has described the major findings of the committee. It is with these findings in mind that the committee began to develop its recommendations for establishing a national center for research on military deployment-related health issues. The following chapter presents the committee's recommendations. TABLE 3.1 Strengths and Limitations of Alternative Locations for a National Center for Military Deployment Health Research Location Strengths Limitations Department of Defense • Existing infrastructure • Research expertise • Resources • Focus on the standing military forces (active-duty and reserves) • Credibility with veterans Department of Veterans Affairs • Existing infrastructure • Research expertise • Resources • Focus on veterans • Credibility with veterans National Institutes of Health • Research expertise • Peer review system • Different mission • No appropriate existing institute Centers for Disease Control and Prevention • Occupational health, prevention, and surveillance expertise • Dissemination of health information • Different mission • Limited basic research infrastructure • Isolated from treatment and surveillance options for populations of interest Universities • Credibility, independence of research • Research expertise • Collaboration of multiple disciplines • Lack of ability to coordinate federal activities • Isolated from treatment and prevention options for populations of interest MVHCB • Cross-departmental. • Incorporate research expertise of federal and private sectors • Mission focused on deployment health