National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

GULF WAR and HEALTH

VOLUME 8

Update of Health Effects of Serving in the Gulf War

Committee on Gulf War and Health: Health Effects of Serving in the Gulf War, Update 2009

Board on the Health of Select Populations

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W.
Washington, DC 20001

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.

This study was supported by Contract No. V101 (93) P-2136, TO 101-E8709(17) between the National Academy of Sciences and Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

International Standard Book Number-13: 978-0-309-14921-1

International Standard Book Number-10: 0-309-14921-5

Additional copies of this report are available from the

National Academies Press,

500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2010 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2010. Gulf War and Health, Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES


Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.


The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.


The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.


The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.


www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

COMMITTEE ON GULF WAR AND HEALTH: HEALTH EFFECTS OF SERVING IN THE GULF WAR, UPDATE 2009

STEPHEN L. HAUSER (Chair), Professor and Chair of Neurology,

University of California, San Francisco, School of Medicine

ALVARO ALONSO, Assistant Professor,

Division of Epidemiology and Community Health, School of Public Health, University of Minnesota

ROBERT H. BROWN, JR., Chair and Professor of Neurology,

University of Massachusetts School of Medicine

DOUGLAS A. DROSSMAN, Co-director,

University of North Carolina Center for Functional GI and Motility Disorder, and

Professor of Medicine and Psychiatry,

University of North Carolina School of Medicine

W. DANA FLANDERS, Professor of Epidemiology, Biostatistics and Bioinformatics,

Emory University Rollins School of Public Health

MATTHEW C. KEIFER, Co-director,

Pacific Northwest Agricultural Safety and Health Center, and

Professor of Occupational Medicine,

University of Washington Harborview Medical Center

FRANCINE LADEN, Associate Professor of Environmental Epidemiology,

Harvard School of Public Health, and

Assistant Professor of Medicine,

Channing Laboratory, Brigham & Women’s Hospital

JENNIFER D. PECK, Assistant Professor of Epidemiology,

University of Oklahoma Health Sciences Center

BEATE R. RITZ, Professor,

Department of Epidemiology, Department of Environmental Health Sciences, and

Vice Chair,

Department of Epidemiology at the University of California, Los Angeles, School of Public Health

REBECCA P. SMITH, Assistant Clinical Professor,

Department of Psychiatry, Mount Sinai Hospital and School of Medicine

EZRA S. SUSSER, Professor of Epidemiology,

Mailman School of Public Health and

Professor of Psychiatry,

College of Physicians and Surgeons at Columbia University

CHRISTINA M. WOLFSON, Director,

Division of Clinical Epidemiology, McGill University Health Centre, and

Professor,

Department of Epidemiology and Biostatistics and Occupational Health, Department of Medicine, McGill University

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

STUDY STAFF

ROBERTA WEDGE, Study Director

RENEE WLODARCZYK, Senior Program Associate

PATRICK BAUR, Research Associate

JOSEPH GOODMAN, Senior Program Assistant

CHRISTIE BELL, Financial Officer

FREDRICK ERDTMANN, Director,

Board on the Health of Select Populations

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

REVIEWERS

This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s (NRC’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:

Alberto Ascherio, Department of Epidemiology, Harvard University School of Public Health

Floyd E. Bloom, Department of Molecular and Integrative Neuroscience, The Scripps Research Institute

Gregory L. Burke, Division of Public Health Sciences, Wake Forest University School of Medicine

Edward V. Loftus, Jr., Division of Gastroenterology and Hepatology, Mayo Clinic

Anne Louise Oaklander, Center for Shingles and Postherpetic Neuralgia, Massachusetts General Hospital

Robert D. Sparks, California Medical Association Foundation

Carol A. Tamminga, Department of Psychiatry, The University of Texas Southwestern Medical Center

Nancy Fugate Woods, University of Washington School of Nursing

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 the report was overseen by Harold C. Sox, American College of Physicians of Internal Medicine. Appointed by the NRC and the Institute of Medicine, he was responsible for making certain that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the author committee and the institution.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

PREFACE

In war, there are no unwounded soldiers.

—José Narosky


The committee began its task with a sense of deep obligation to the servicemen and women who fought so bravely on our behalf in the Gulf War theater. Our appreciation of the risks, privations, and sacrifices that these courageous servicemembers undertook only deepened as our knowledge of the combat mission increased during the course of the committee’s meetings. There is no greater service that a human being can provide to one’s fellow citizens than to risk life and health on their behalf. We are honored to dedicate this report to these troops.

As scientists and clinicians, the committee members are also aware of our responsibilities not only to those who served in the Gulf War coalition but also to the cause of science and evidence-based medicine. Only by being true to the latter do we serve the former.

There is no doubt that many of the veterans deployed to the gulf region during 1990-1991 have continued to experience troubling constellations of symptoms involving multiple body systems; these have been variously termed multisymptom illness or Gulf War illness, and as such are emblazoned in the public’s mind as a consequence of military service in this battleground. Many other veterans have not experienced the full array of Gulf War illness symptoms but continue to suffer from seemingly related symptoms, including persistent fatigue, chronic fatigue syndrome, irritable bowel syndrome, memory problems, headache, bodily pains, disturbances of sleep, as well as other physical and emotional problems. Many of these symptoms are difficult to categorize as they have no known cause, no objective findings on clinical examination, no diagnostic biomarkers, no known tissue pathology, and no curative therapy. The inadequate basic understanding of the root cause of these symptoms highlights the limitations of current medical science and clinical practice. The committee recognizes that symptoms that cannot be easily quantified are sometimes dismissed—incorrectly—as insignificant, and that they receive inadequate attention—and funding—by the medical and scientific establishment. For example, chronic pain is experienced by 81 million people in the United States alone, yet funding to understand the biology of pain is woefully inadequate, clinical care pathways for individuals suffering from pain are underdeveloped, and training in pain medicine for clinicians lags behind the training for far less common maladies.

Many of the complaints experienced by Gulf War veterans, veterans who arrived in the Gulf War theater after the hostilities ended, and nondeployed veterans, are also seen in the general population. It is beyond dispute, however, that the prevalence of symptoms such as headaches, joint pain, and difficulty concentrating is higher in veterans deployed to the Gulf War theater than the others.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

During the past decade two groups, the Institute of Medicine (IOM) and the congressionally mandated Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC) have been charged with evaluating the health of and research on Gulf War veterans. In the 2006 IOM report Gulf War and Health, Volume 4: Health Effects of Serving in the Gulf War, the authoring committee concluded that although Gulf War veterans reported higher levels of symptoms that might be associated with exposures in the field, no associations with any specific exposures could be identified. In contrast, a report issued by the RAC in November 2008 concluded that Gulf War illness resulted from exposure to pyridostigmine bromide, pesticides, and possibly other exposures.

Although not formally charged with investigating evidence that exposure to specific environmental hazards may have been associated with multisymptom illness, this committee was asked by General Shinseki, Secretary of the Department of Veterans Affairs, to comment on it and did so in an appendix. To ignore this question would not serve the larger purpose of our inquiry. We conclude that current evidence is inadequate to determine whether an association exists between multisymptom illness and any specific battlefield exposure or exposures. Veterans who continue to suffer from these discouraging symptoms deserve the very best that modern science and medicine can offer to delineate the true underlying cause of these symptoms in order to speed the development of effective treatments, cures, and, it is hoped, preventions. The committee suggests a path forward to accomplish these goals and we believe that, through a concerted national effort and rigorous scientific input, answers can likely be found.

The committee would like to thank the many Gulf War veterans who spoke with us about their experiences in the gulf and upon their return to the United States. They provided valuable insights into the symptoms and medical conditions that have been the legacy of the Gulf War for many of the men and women who served in the military. The committee also appreciated hearing from representatives from the Department of Veterans Affairs about the facilities and programs available to Gulf War veterans and from representatives of the RAC who presented the findings of that committee and answered this committee’s questions. And finally, the committee would like to thank the IOM staff—Patrick Baur, Joseph Goodman, Renee Wlodarczyk—who assisted in this effort. In particular, we thank Roberta Wedge, who guided the entire process with flexibility, provided many invaluable insights, and displayed a sure hand at every step along our path.


Stephen L. Hauser (Chair)

Committee on Gulf War and Health: Health Effects of Serving in the Gulf War, Update 2009

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

CONTENTS

 

 

PREFACE

 

ix

 

 

ACRONYMS

 

xvii

 

 

SUMMARY

 

1

   

 Charge to the Committee

 

2

   

 Committee’s Approach

 

2

   

 Volume 4 Conclusions

 

3

   

 Considerations in Identifying and Evaluating the Literature

 

4

   

 Primary and Secondary Studies

 

4

   

 Categories of Association

 

5

   

 Major Cohort Studies

 

6

   

 Health Outcomes

 

6

   

 Quality of the Studies

 

7

   

 Recommendations

 

9

1

 

INTRODUCTION

 

11

   

 Background

 

11

   

 The Gulf War Setting

 

12

   

 Deployment

 

13

   

 Living Conditions

 

13

   

 Environmental and Chemical Exposures

 

13

   

 Threat of Chemical and Biologic Warfare

 

14

   

 Charge to the Committee

 

15

   

 Committee’s Approach to Its Charge

 

16

   

 Complexities in Resolving Gulf War and Health Issues

 

17

   

 Multiple Exposures and Chemical Interactions

 

17

   

 Limitations of Exposure Information

 

17

   

 Individual Variability

 

18

   

 Volume 4 Conclusions

 

18

   

 Organization of the Report

 

20

   

 References

 

20

2

 

CONSIDERATIONS IN IDENTIFYING AND EVALUATING THE LITERATURE

 

23

   

 Identification of the Literature

 

23

   

 Types of Evidence

 

25

   

 Epidemiologic Studies

 

25

   

 Associations in Epidemiologic Studies

 

25

   

 Inferring Causality

 

27

   

 Types of Epidemiologic Studies

 

28

   

 Cohort Studies

 

28

   

 Case-Control Studies

 

29

   

 Cross-Sectional Studies

 

30

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
   

 Standardized Mortality Studies

 

31

   

 Inclusion Criteria

 

31

   

 Methodologic Rigor

 

32

   

 Exposure Assessment

 

32

   

 Health Outcome Assessment

 

32

   

 Considerations in Assessing the Strength of Evidence

 

33

   

 Categories of Association

 

33

   

 Additional Considerations

 

35

   

 Bias

 

35

   

 Confounding

 

35

   

 Sampling Error

 

35

   

 Multiple Comparisons

 

36

   

 Limitations of Gulf War Veteran Studies

 

36

   

 References

 

36

3

 

MAJOR COHORT STUDIES

 

39

   

 General Limitations of Gulf War Cohort Studies and Derivative Studies

 

39

   

 Organization of this Chapter

 

41

   

 Department of Veterans Affairs Study

 

45

   

 The Iowa Persian Gulf Study

 

49

   

 United Kingdom Veteran Studies

 

51

   

 Australian Veteran Studies

 

54

   

 Danish Peacekeeper Studies

 

56

   

 Oregon and Washington Veteran Studies

 

57

   

 Canadian Gulf War Veterans Study

 

58

   

 Kansas Veteran Study

 

58

   

 Fort Devens and New Orleans Cohort Studies

 

59

   

 Seabee Studies

 

60

   

 Pennsylvania Air National Guard Study

 

62

   

 Hawaii and Pennsylvania Active Duty and Reserve Study

 

62

   

 New Orleans Reservist Studies

 

63

   

 References

 

63

4

 

HEALTH OUTCOMES

 

71

   

 Organization of the Chapter

 

71

   

 Cancer

 

73

   

 Summary of Volume 4

 

73

   

 Updated and Supplemental Literature

 

75

   

 Summary and Conclusions

 

78

   

 Diseases of the Blood and Blood-Forming Organs

 

83

   

 Updated and Supplemental Literature

 

83

   

 Summary and Conclusions

 

85

   

 Endocrine, Nutritional, and Metabolic Diseases

 

89

   

 Diabetes

 

89

   

 Thyroid Disease

 

91

   

 Obesity

 

92

   

 Hospitalization Studies

 

93

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
   

 Mortality Studies

 

95

   

 Summary and Conclusions

 

95

   

 Mental and Behavioral Disorders

 

99

   

 Summary of Volume 4

 

101

   

 Updated and Supplemental Literature

 

105

   

 Summary and Conclusion

 

108

   

 Neurocognitive and Neurobehavioral Outcomes

 

115

   

 Summary of Volume 4

 

115

   

 Updated and Supplemental Literature

 

116

   

 Summary and Conclusions

 

118

   

 Diseases of the Nervous System

 

121

   

 Peripheral Neuropathy and Myopathy

 

121

   

 Multiple Sclerosis

 

124

   

 Amyotrophic Lateral Sclerosis

 

126

   

 Other Neurodegenerative Diseases

 

129

   

 Other Neurological Outcomes

 

130

   

 Diseases of the Circulatory System

 

135

   

 Summary of Volume 4

 

135

   

 Updated and Supplemental Literature

 

136

   

 Summary and Conclusions

 

140

   

 Diseases of the Respiratory System

 

145

   

 Summary of Volume 4

 

145

   

 Updated and Supplemental Literature

 

147

   

 Summary and Conclusions

 

149

   

 Diseases of the Digestive System

 

154

   

 Summary of Volume 4

 

155

   

 Updated and Supplemental Epidemiologic Literature

 

156

   

 Summary and Conclusions

 

159

   

 Skin Diseases

 

164

   

 Summary of Volume 4

 

164

   

 Updated and Supplemental Literature

 

165

   

 Summary and Conclusions

 

167

   

 Diseases of the Musculoskeletal System

 

169

   

 Summary of Volume 4

 

169

   

 Updated and Supplemental Literature

 

170

   

 Summary and Conclusion

 

171

   

 Fibromyalgia and Chronic Widespread Pain

 

175

   

 Summary of Volume 4

 

175

   

 Updated and Supplemental Literature

 

176

   

 Summary and Conclusion

 

178

   

 Diseases of the Genitourinary System

 

180

   

 Genitourinary Outcomes

 

180

   

 Hospitalization for Genitourinary System Diseases

 

183

   

 Summary and Conclusions

 

184

   

 Adverse Reproductive and Perinatal Outcomes

 

189

   

 Birth Defects

 

189

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
   

 Adverse Pregnancy Outcomes

 

193

   

 Fertility

 

195

   

 Sexual Dysfunction

 

198

   

 Multisymptom Illnesses

 

204

   

 Factor Analyses and Surveys

 

204

   

 Hospitalization Studies

 

207

   

 Other Reports

 

208

   

 Summary and Conclusions

 

210

   

 Chronic Fatigue Syndrome

 

210

   

 External Causes of Mortality

 

221

   

 Summary of Volume 4

 

221

   

 Updated and Supplemental Literature

 

222

   

 Summary and Conclusions

 

224

   

 Female Veterans’ Health

 

228

   

 Deployment Experiences

 

228

   

 Health Effects

 

229

   

 Mental Health Effects

 

231

   

 Military Sexual Assault and Harassment

 

232

   

 Hospitalization and Mortality

 

233

   

 Summary and Conclusions

 

234

   

 References

 

235

5

 

CONCLUSIONS AND RECOMMENDATIONS

 

255

   

 Quality of the Studies

 

258

   

 Possible Causes of Multisymptom Illness in Veterans

 

259

   

 The Path Forward

 

260

APPENDIX A

 

CHOLINESTERASE INHIBITORS AND MULTISYMPTOM ILLNESSES

 

265

   

 Exposures to Cholinesterase Inhibitors and Other Pesticides During the Gulf War

 

266

   

 Pesticides

 

266

   

 Long-Term Effects of Low Doses of Cholinesterase Inhibitors

 

270

   

 Studies in Gulf War Populations

 

271

   

 Animal Studies

 

275

   

 Genetic Susceptibility to Cholinesterase Inhibitors

 

276

   

 The Role of Cholinesterase Inhibitors and Pesticides in Multisymptom Illness

 

278

   

 References

 

279

APPENDIX B

 

COMMITTEE BIOGRAPHICAL SKETCHES

 

285

 

 

INDEX

 

289

Tables and Boxes

TABLE 3-1

 

Reference and Derivative Studies for the Major Gulf War Cohorts

 

42

TABLE 4-1

 

Cancer

 

79

TABLE 4-2

 

Diseases of the Blood and Blood-Forming Organs

 

86

TABLE 4-3

 

Endocrine, Nutritional, and Metabolic Diseases

 

96

TABLE 4-4

 

Mental and Behavioral Disorders

 

110

TABLE 4-5

 

Neurobehavioral and Neurocognitive Outcomes

 

119

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

TABLE 4-6

 

Nervous System Diseases

 

132

TABLE 4-7

 

Circulatory System Diseases

 

141

TABLE 4-8

 

Respiratory System Diseases

 

150

TABLE 4-9

 

Digestive System Diseases

 

162

TABLE 4-10

 

Skin Diseases

 

168

TABLE 4-11

 

Musculoskeletal Diseases

 

172

TABLE 4-12

 

Fibromyalgia and Chronic Widespread Pain

 

179

TABLE 4-13

 

Diseases of the Genitourinary System

 

186

TABLE 4-14

 

Adverse Reproductive and Perinatal Outcomes

 

200

TABLE 4-15

 

Multisymptom Illnesses

 

215

TABLE 4-16

 

External Causes of Mortality

 

225

BOX S-1

 

Summary of Findings Regarding Associations Between Deployment to the Gulf War and Specific Health Outcomes

 

8

BOX 1-1

 

Brief Summary of Findings and Recommendations

 

19

BOX 4-1

 

CDC Case Definition of Chronic Fatigue Syndrome

 

212

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

This page intentionally left blank.

Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

ACRONYMS

AChE acetylcholinesterase

ACR American College of Rheumatology

AFQT Armed Forces Qualifying Test

ALS amyotrophic lateral sclerosis

ANCOVA analysis of covariance

BAI Beck Anxiety Inventory

BDI Beck Depression Inventory

BIRLS Beneficiary Identification Records Locator System

BMI body mass index

BSI Brief Symptom Inventory

BuChE butyrylcholinesterase

CAPS Clinician Administered PTSD Scale

CCD Canadian Cancer Database

CCEP Comprehensive Clinical Evaluation Program

CDC Centers for Disease Control and Prevention

CES Combat Exposure Scale

CFS chronic fatigue syndrome

CI confidence interval

CIDI Composite International Diagnostic Interview

CMD Canadian Mortality Database

CMI chronic multisymptom illness

CMV cytomegalovirus

CNS central nervous system

COD cause of death

COSHPD California Office of Statewide Health Planning and Development

CRP C-reactive protein

CVLT California Verbal Learning Test

CWP chronic widespread pain

DASA Defence Analytical Services Agency (United Kingdom)

DMDC Defense Manpower Data Center

DNA deoxyribonucleic acid

DND Department of National Defence (Canada)

DoD Department of Defense

DSM Diagnostic and Statistical Manual of Mental Disorders

DSP distal symmetric polyneuropathy

DU depleted uranium

EBV Epstein-Barr virus

EEG electroencephalography

ESR erythrocyte sedimentation rate

FARS Fatality Analysis Reporting System

FEV1 forced expiratory volume in 1 second

Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

FGID functional gastrointestinal disorder

FSH follicle stimulating hormone

FVC forced vital capacity

GAD generalized anxiety disorder

GAO Government Accountability Office

GHQ-12 12-item General Health Questionnaire

GI gastrointestinal

GW Gulf War

GWV Gulf War deployed veterans

HIV human immunodeficiency virus

HPA hypothalamic-pituitary-adrenal axis

HR hazard ratio

HSC Health Symptoms Checklist

IBS irritable bowel syndrome

ICD International Statistical Classification of Diseases and Related Health Problems

IOM Institute of Medicine

LH luteinizing hormone

MANOVA multivariate analysis of variance

MCH mean corpuscular hemoglobin

MCS multiple chemical sensitivity

MCV mean corpuscular volume

MDD major depressive disorder

MRR mortality rate ratio

MS multiple sclerosis

NART National Adults Reading Test

NAS National Academy of Sciences

NDI National Death Index

NDV nondeployed veterans

NIH National Institutes of Health

NIS neuropathy impairment score

NOAA National Oceanic and Atmospheric Administration

NTE neuropathy target esterase

ODTP Oregon Dual Task Procedure

OPIDP organophosphate-induced delayed polyneuropathy

OR odds ratio

PASAT Paced Auditory Serial Addition Test

PB pyridostigmine bromide

PCL patient checklist

PCL-C Patient Checklist-Civilian

PCL-M Patient Checklist-Military

PFT pulmonary function test

PHQ Patient Health Questionnaire

PIR proportional incidence ratio

PMR proportional morbidity ratio

PON1 paraoxonase-1

POW prisoner of war

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

PR prevalence ratio

PRIME-MD Primary Care Evaluation of Mental Disorders

PTSD posttraumatic stress disorder

QoLI quality of life index

RAC VA Research Advisory Committee on Gulf War Veterans’ Illnesses

RoM ratio of means

RR relative risk (or risk ratio as indicated in text)

SCAN Schedule for Clinical Assessment and Diagnosis

SCID Structured Clinical Interview for DSM-III-R

Sd standard deviation

SF-12 12-Item Short Form Health Survey

SF-36 36-Item Short Form Health Survey

SMR standardized mortality ratio

SNAP Schedule for Nonadaptive and Adaptive Personality

SSA Social Security Administration

TBI traumatic brain injury

TOMM Test of Memory Malingering

UK United Kingdom

VA Department of Veterans Affairs

WAIS Wechsler Adult Intelligence Scale

WCST Wisconsin Card Sorting Test

WHO World Health Organization

WMS Wechsler Memory Scale

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R1
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R2
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R3
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R4
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R5
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R6
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R8
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R9
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R10
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R11
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R13
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R14
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R15
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R16
Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R17
Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R18
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R19
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/12835.
×
Page R20
Next: SUMMARY »
Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War Get This Book
×
Buy Hardback | $69.00 Buy Ebook | $54.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

For the United States, the 1991 Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the IOM is conducting an ongoing review of the evidence to determine veterans' long-term health problems and what might be causing those problems. The fourth volume in the series, released in 2006, summarizes the long-term health problems seen in Gulf War veterans. In 2008, the IOM began an update to look at existing health problems and identify possible new ones, considering evidence collected since the initial summary.

In this report, the IOM determines that Gulf War service causes post-traumatic stress disorder (PTSD) and that service is associated with multisymptom illness; gastrointestinal disorders such as irritable bowel syndrome; alcohol and other substance abuse; and anxiety disorders and other psychiatric disorders. To ensure that our veterans receive the best possible care, now and in the future, the government should continue to monitor their health and conduct research to identify the best treatments to assist Gulf War veterans still suffering from persistent, unexplained illnesses.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!