ble health effects of other agents and treatments for the veterans’ health problems. Extensive research and policy efforts continue. In addition to the panels identified in Box 1.1, there are ongoing efforts by individual veterans, veteran service organizations, academia, Congress, federal agencies, private sector organizations, and others. These efforts focus on the spectrum of work needed to fulfill the goal of improving the health of Gulf War veterans who are ill and preventing illnesses in future deployments. This work includes clinical research on the effectiveness of potential treatments, improving exposure models, epidemiologic research on the health status of Gulf War veterans, research on the nature of the veterans’ illnesses, and studies on the potential adverse health effects of the agents that were likely present in the Gulf War.

Complexities in Resolving Gulf War Health Issues

Investigations of the health effects of past wars have often focused on narrowly defined hazards or health outcomes, such as infectious diseases (e.g., typhoid, malaria) during the Civil War, specific chemical hazards (e.g., mustard gas in World War I, Agent Orange and other herbicides in Vietnam), and combat injuries. A discussion of the possible health effects of the Gulf War, however, involves many complex issues, some of which are explored below. These include exposure to multiple biological and chemical agents, limited exposure information, individual variability factors, and illnesses that are often nonspecific and lack defined medical diagnoses or treatment protocols. While, the committee was not tasked with addressing these issues it presents them in this introductory chapter to acknowledge the difficulties faced by veterans, researchers, policymakers, and others in reaching an understanding about the veterans’ ill health.

Multiple Exposures and Chemical Interactions

Although Operation Desert Shield/Desert Storm was relatively short in duration, military personnel were potentially exposed to numerous agents. Many of the exposures are not unique to the Gulf War, however, the number of agents and the combination of agents to which the veterans may have been exposed make it difficult to determine whether any one agent, or combination of agents, is the cause of Gulf War veterans’ illnesses. These include preventive measures (e.g., PB, vaccines, pesticides, insecticides), hazards of the natural environment (e.g., sand, endemic diseases), job-specific exposures (e.g., paints, solvents, diesel fumes), war-related exposures (e.g., smoke from burning oil-well fires, DU), and hazards from cleanup operations (e.g., sarin and cyclosarin). Thus, military personnel may have been exposed to a variety of agents, at varying doses, and lengths of time. The literature on the agents, however, is quite limited with regard to combinations of biological and chemical agents and their interactions.

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