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Suggested Citation:"Front Matter." Institute of Medicine. 2014. Chronic Multisymptom Illness in Gulf War Veterans: Case Definitions Reexamined. Washington, DC: The National Academies Press. doi: 10.17226/18623.
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Chronic Multisymptom Illness in Gulf War
Veterans: Case Definitions Reexamined

Committee on the Development of a Consensus Case Definition for Chronic
Multisymptom Illness in 1990–1991 Gulf War Veterans

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. 2014. Chronic Multisymptom Illness in Gulf War Veterans: Case Definitions Reexamined. Washington, DC: The National Academies Press. doi: 10.17226/18623.
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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.

This study was supported by Contract VA240-13-D-0024 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

International Standard Book Number-13: 978-0-309-29876-6
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IOM (Institute of Medicine). 2014. Chronic Multisymptom Illness in Gulf War Veterans: Case Definitions Reexamined. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Chronic Multisymptom Illness in Gulf War Veterans: Case Definitions Reexamined. Washington, DC: The National Academies Press. doi: 10.17226/18623.
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    OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Chronic Multisymptom Illness in Gulf War Veterans: Case Definitions Reexamined. Washington, DC: The National Academies Press. doi: 10.17226/18623.
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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. C. D. Mote, Jr., 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. C. D. Mote, Jr. are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Chronic Multisymptom Illness in Gulf War Veterans: Case Definitions Reexamined. Washington, DC: The National Academies Press. doi: 10.17226/18623.
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COMMITTEE ON THE DEVELOPMENT OF A CONSENSUS CASE DEFINITION FOR CHRONIC MULTISYMPTOM ILLNESS IN 1990–1991 GULF WAR VETERANS

KENNETH SHINE (Chair), Special Adviser to the Chancellor, University of Texas, Austin, TX

FLOYD E. BLOOM, Professor Emeritus, Molecular and Integrative Neuroscience Department, The Scripps Research Institute, LaJolla, CA

KARON FRANCES COOK, Research Associate Professor, Northwestern University Feinberg School of Medicine, Chicago, IL

DEBORAH A. CORY-SLECHTA, Professor, Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY

FRED FRIEDBERG, Research Associate Professor, Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY

JOANNA G. KATZMAN, Director, University of New Mexico Pain Center and Associate Professor, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM

HOWARD M. KIPEN, Professor of Environmental and Occupational Medicine and Chief, Clinical Research and Occupational Medicine Division, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ

JEANNIE-MARIE S. LEOUTSAKOS, Assistant Professor, Director, Psychiatry Biostatistics and Methodology Core, Johns Hopkins University School of Medicine, Baltimore, MD

JAMES L. LEVENSON, Professor of Psychiatry, Internal Medicine and Surgery, Virginia Commonwealth University, Richmond, VA

CATHERINE LOMEN-HOERTH, Director, ALS Center, Professor of Neurology, University of California, San Francisco, Medical Center, San Francisco, CA

THOMAS J. MASON, Professor, Department of Environmental and Occupational Health, College of Public Health, Department of Internal Medicine, College of Medicine, University of South Florida, Tampa, FL

LINDA ANH B. NGUYEN, Clinical Assistant Professor, Director, GI Motility and Neurogastroenterology, Stanford University, Palo Alto, CA

F. JAVIER NIETO, Helfaer Professor of Public Health, Professor of Population Health Sciences and Family Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI

ANNE LOUISE OAKLANDER, Associate Professor of Neurology, Harvard Medical School, Assistant in Pathology (Neuropathology), Massachusetts General Hospital, Boston, MA

RON F. TEICHMAN, Teichman Occupational Health Associates, Inc., West Orange, NJ

SUZANNE D. VERNON, Scientific Director, The CFIDS Association of America, Charlotte, NC

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Chronic Multisymptom Illness in Gulf War Veterans: Case Definitions Reexamined. Washington, DC: The National Academies Press. doi: 10.17226/18623.
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IOM Staff

CAROLYN FULCO, Scholar

RENEE WLORDCZYK, Associate Program Officer (until August 2013)

CARY HAVER, Associate Program Officer

NORMAN GROSSBLATT, Senior Editor

JOSEPH GOODMAN, Senior Program Assistant

SULVIA DOJA, Senior Program Assistant

DORIS ROMERO, Financial Associate

FREDERICK ERDTMANN, Director, Board on the Health of Select Populations

Consultants

MIRIAM DAVIS, Independent Consultant, Silver Spring, MD

ANDREW KAYSER, Ernest Gallo Clinic & Research Center, University of California, San Francisco, San Francisco, CA

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Chronic Multisymptom Illness in Gulf War Veterans: Case Definitions Reexamined. Washington, DC: The National Academies Press. doi: 10.17226/18623.
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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 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 of 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 thank the following for their review of this report:

John C. Bailar, University of Chicago

Dan G. Blazer, Duke University Medical Center

Kenneth W. Kizer, University of California Davis

David Korn, Harvard University

Kurt Kroenke, Indiana University School of Medicine

Eric B. Larson, Group Health Research Institute

Stephen R. Mitchell, Georgetown University School of Medicine

Rebecca Nugent, Carnegie Mellon University

Tyler Smith, National University

Simon Wessely, Kings College London

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 Huda Akil, University of Michigan, and Harold C. Sox, Dartmouth Institute for Health Policy and Clinical Practice. Appointed by the National Research Council and the Institute of Medicine, they were 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.

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More than 2 decades have passed since the 1990-1991 conflict in the Persian Gulf. During the intervening years, many Gulf War veterans have experienced various unexplained symptoms that many associate with service in the gulf region, but no specific exposure has been definitively associated with symptoms. Numerous researchers have described the pattern of signs and symptoms found in deployed Gulf War veterans and noted that they report unexplained symptoms at higher rates than nondeployed veterans or veterans deployed elsewhere during the same period. Gulf War veterans have consistently shown a higher level of morbidity than the nondeployed, in some cases with severe and debilitating consequences. However, efforts to define a unique illness or syndrome in Gulf War veterans have failed, as have attempts to develop a uniformly accepted case definition.

Chronic Multisymptom Illness in Gulf War Veterans is a comprehensive review of the available scientific and medical literature regarding symptoms for chronic multisymptom illness (CMI) among the 1991 Gulf War Veterans. This report evaluates and summarizes the literature in an effort to identify appropriate terminology to use in referring to CMI in Gulf War Veterans. While the report does not recommend one specific case definition over another, Chronic Multisymptom Illness in Gulf War Veterans does recommend the consideration of two case definitions on the basis of their concordance with the evidence and their ability to identify specific symptoms commonly reported by Gulf War veterans. This report recommends that the Department of Veterans Affairs use the term Gulf War illness rather than CMI. The report recommends that that the Department of Veterans Affairs, to the extent possible, systematically assess existing data to identify additional features of Gulf War illness, such as onset, duration, severity, frequency of symptoms, and exclusionary criteria to produce a more robust case definition.

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