Gulf War Veterans
TREATING SYMPTOMS AND SYNDROMES
Committee on Identifying Effective Treatments for Gulf War Veterans' Health Problems
Board on Health Promotion and Disease Prevention
Bernard M. Rosof and Lyla M. Hernandez, Editors
INSTITUTE OF MEDICINE
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.
Support for this project was provided by the Department of Veterans Affairs. The views presented in this report are those of the Institute of Medicine's Committee on Identifying Effective Treatments for Gulf War Veterans' Health and are not necessarily those of the funding agencies.
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COMMITTEE ON IDENTIFYING EFFECTIVE TREATMENTS FOR GULF WAR VETERANS' HEALTH PROBLEMS
Bernard M. Rosof, MD (Chair), Senior Vice President, Clinical Affairs/Quality, North Shore-Long Island Jewish Health System, Great Neck, NY
Dan G. Blazer, III, MD, PhD, MPH, JP Gibbons Professor of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
Donald W. Black, MD, Professor of Psychiatry, University of Iowa College of Medicine, Iowa City, IA
Dedra Buchwald, MD, Professor, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA
John J. Halperin, MD, Professor of Neurology, NYU School of Medicine, and Chair, Department of Neurology, North Shore University Hospital, Manhasset, NY
Isabel V. Hoverman, MD, Austin Internal Medicine Associates, L.L.P., Austin, TX, and Clinical Assistant Professor of Medicine, University of Texas Medical Branch, Galveston, TX
Alvin I. Mushlin, MD, ScM, Professor and Chairman, Department of Public Health, Weill Medical College, Cornell University, New York, NY
David R. Nerenz, PhD, Professor, College of Human Medicine, Director, Health Care Studies, Institute for Managed Care, Michigan State University, East Lansing, MI
John A. Rich, MD, MPH, Medical Director, Boston Public Health Commission, and Associate Professor, Boston University School of Medicine, Boston, MA
Kenneth G. Saag, MD, MSc, Associate Professor, Division of Rheumatology and Clinical Immunology, and Director, Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham, Birmingham, AL
Lyla M. Hernandez, Study Director
Patricia Spaulding, Project Assistant
Gabor Erdelyi, Project Assistant
Rose Marie Martinez, Director, Division of Health Promotion and Disease Prevention
Rita Gaskins, Division Assistant
Melissa French, Financial Associate
The committee wishes to express its appreciation to the many individuals who contributed in various ways to the completion of this project. Charles C. Engel, Jr, M.D., and Wayne J. Katon, M.D., wrote a paper providing an exceptional description of current efforts to understand the clinical management of medically unexplained physical symptoms. Chapter 5 contains material abstracted from that paper. Stephen Hunt, M.D., and Ralph Richardson, Ph.D., shared with the committee their experiences in treating Gulf War veterans' health problems; Howard Spiro, M.D., provided insight into the diagnosis and treatment of irritable bowel syndrome; and many Gulf War veterans and other interested individuals addressed the committee during its August 2000 meeting. A summary of the testimony appears in the report as Appendix B.
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its 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. We wish to thank the following individuals for their review of this report: Gerard N. Burrow, M.D., Yale University School of Medicine; Nelson Gantz, M.D., Chairman, Department of Medicine, and Chief, Division of Infectious Diseases, Pinnacle Health Hospitals; William Golden, M.D., University of Arkansas for Medical Sciences; John E. Helzer, M.D., Health Behavior
Research Center of the University of Vermont; Richard T. Johnson, M.D., Professor of Neurology, Microbiology, and Neuroscience, The Johns Hopkins University School of Medicine and Bloomberg School of Public Health; Lauren B. Krupp, M.D., State University of New York at Stony Brook; David Mechanic, Ph.D., Institute for Health, Health Care Policy and Aging Research, Rutgers University; Michael H. Weisman, M.D., Director, Division of Rheumatology, Cedars-Sinai Medical Center, and Professor of Medicine, University of California at Los Angeles; and John D. Wynn, M.D., University of Washington.
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Robert B. Wallace, M.D., University of Iowa College of Public Health, appointed by the Institute of Medicine, and Harold C. Sox, M.D., Dartmouth-Hitchcock Medical Center, appointed by the NRC's Report Review Committee, who were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.