1
Introduction

A large body of research exists on the health effects of military conflicts, from the U.S. Civil War through the recent conflicts in the 1991 Gulf War and Bosnia. Research on the effects of mustard gas and Agent Orange has contributed greatly to knowledge about the health problems associated with exposure to such agents. Following the end of the Gulf War in 1991, a new wave of research on the effects of that war was begun.

Information obtained from the numerous studies of veterans of specific conflicts has given rise to broader questions regarding the consequences of service in any major military engagement. Concern now is being focused on questions of war-related illnesses and postdeployment health issues, with the ultimate goal of finding ways to prevent, or at least mitigate, the consequences of such potential problems. One approach being considered is the establishment of a national center for the study of war-related illnesses and postdeployment health issues.

The Department of Veterans Affairs asked the Institute of Medicine to assist the VA in developing a plan for establishing a national center (or centers) for the study of war-related illnesses and postdeployment health issues, as well as to assess preliminary VA plans regarding such efforts. To conduct this study, the IOM convened a committee composed of experts on war-related illnesses, clinical research, military medicine, epidemiology, health services research, operations research, development of interdisciplinary research centers, research ethics, technology transfer, and the integration of clinical and education programs with research.



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National Center for Military Deployment Health Research 1 Introduction A large body of research exists on the health effects of military conflicts, from the U.S. Civil War through the recent conflicts in the 1991 Gulf War and Bosnia. Research on the effects of mustard gas and Agent Orange has contributed greatly to knowledge about the health problems associated with exposure to such agents. Following the end of the Gulf War in 1991, a new wave of research on the effects of that war was begun. Information obtained from the numerous studies of veterans of specific conflicts has given rise to broader questions regarding the consequences of service in any major military engagement. Concern now is being focused on questions of war-related illnesses and postdeployment health issues, with the ultimate goal of finding ways to prevent, or at least mitigate, the consequences of such potential problems. One approach being considered is the establishment of a national center for the study of war-related illnesses and postdeployment health issues. The Department of Veterans Affairs asked the Institute of Medicine to assist the VA in developing a plan for establishing a national center (or centers) for the study of war-related illnesses and postdeployment health issues, as well as to assess preliminary VA plans regarding such efforts. To conduct this study, the IOM convened a committee composed of experts on war-related illnesses, clinical research, military medicine, epidemiology, health services research, operations research, development of interdisciplinary research centers, research ethics, technology transfer, and the integration of clinical and education programs with research.

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National Center for Military Deployment Health Research The committee held three meetings, the first of which included an information gathering workshop (Appendix A); reviewed and discussed published research and information about war-related illnesses and postdeployment health issues; examined various approaches to evaluate and fund national centers; identified key elements necessary for development and implementation of such centers; and developed its recommendations. STRUCTURE OF THE REPORT Chapter 2 summarizes information analyzed by the committee. Chapter 3 presents the committee's findings. Chapter 4 describes the committee's recommendations for development of a National Center for Military Deployment Health Research. In addition, this chapter assesses the VA's plans for proposed centers to study war-related illness and postdeployment health, develops an overview of the purpose and Scope of a National Center, analyzes options for organizational structure and placement, and discusses the need for adequate funding and support. The final chapter summarizes the report and provides the committee's conclusions.