In response to these concerns, the Department of Veterans Affairs (VA) approached the National Academy of Sciences and requested that the Institute of Medicine (IOM) conduct a study to evaluate the published scientific literature concerning the association between the agents to which the Gulf War veterans may have been exposed and adverse health effects. To carry out the VA charge, the IOM formed the Committee on Health Effects Associated with Exposures During the Gulf War. The committee began its deliberations in January 1999 by choosing the initial group of compounds for study. The committee decided to select the compounds of most concern to the veterans. Following meetings with representatives of different veterans’ organizations, the committee decided to study the following compounds: depleted uranium, chemical warfare agents (sarin and cyclosarin), pyridostigmine bromide, and vaccines (anthrax and botulinum toxoid). Additional IOM studies will examine the remaining agents.

The committee met with veterans and leaders of veterans’ organizations many times throughout the course of the study. These meetings were invaluable for the committee in providing an important perspective on the veterans’ experiences and concerns. Further, ongoing discussions with and written input from veterans became an integral part of the manner in which the committee conducted the study and greatly enhanced its process.

Subsequent to the VA–IOM contract, two public laws were passed: the Veterans Programs Enhancement Act of 1998 (Public Law 105-368) and the Persian Gulf War Veterans Act of 1998 (Public Law 105-277). Each law mandated studies similar to the study already agreed upon by the VA and IOM. These laws detail several comprehensive studies on veterans’ health and specify many biological and chemical hazards that may potentially be associated with the health of Gulf War veterans.

The charge to the IOM committee was relatively narrow: to assess the scientific literature regarding potential health effects of chemical and biological agents present in the Gulf War. The committee was not asked to determine whether a unique Gulf War syndrome exists, nor was it to make judgments regarding the veterans’ levels of exposure to the putative agents. In addition, the committee’s charge was not to focus on broader issues, such as the potential costs of compensation for veterans or policy regarding such compensation. These decisions remain the responsibility of the Secretary of Veterans Affairs. This report provides an assessment of the scientific evidence regarding health effects that may be associated with exposures to specific agents that were present in the Gulf. The Secretary may consider these health effects as the VA develops a compensation program for Gulf War veterans.

METHODOLOGY

The committee’s charge was to conduct a review of the scientific literature on the possible health effects of agents to which Gulf War veterans may have been exposed. The breadth of this review included all relevant toxicological, animal, and human studies. Because only a few studies describe the veterans’ exposures,



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