Research and Evaluation

An extensive research program has been initiated by VA, DoD, and the Department of Health and Human Services (HHS) to investigate Gulf War health questions.31 Over 200 million dollars has been allocated for this research effort in the U.S. A total of 224 federally-funded Gulf War related research studies have been authorized to date. As of January 2002, 140 projects had been completed and 88 were still in progress. The British, Canadian, and Australian governments also mounted an extensive clinical and research effort to evaluate and care for their populations of Gulf War veterans.17,18,116 Further information on U.S. sponsored Gulf War research can be obtained at http://www.va.gov/gulfwar and http://www.va.gov/resdev/prt/gulf_war_2001.

In epidemiological surveys of diverse populations of Gulf War troops, veterans consistently have reported higher rates of elicited symptoms and illnesses compared to non-deployed control groups.17,91,117-122 However, large-scale epidemiological studies based on DoD hospitalization records found no overall increase in hospitalization rates among Gulf War veterans,123 no increase in specific diseases like systemic lupus erythematosus 22 or testicular cancer,21 and no indication of a new syndrome.124,125 Also, two large epidemiological studies that utilized DoD and civilian State medical records found no increase in the overall rate of birth defects among children born after the war to Gulf War veterans.126,127 A comprehensive study of the U.S. Gulf War veteran population based on death certificate records found the mortality rate in this population to be comparable to non-deployed era veterans for the first 7 years after the war with Iraq.128,129 As observed among veterans of WWII, Korea, and Vietnam, a slightly increased death rate from external causes, principally motor vehicle accidents, was found among Gulf War veterans for the first few years after the war. However, Gulf war veterans are now no more likely to die of external causes than other military personnel.129 In addition, compared to the demographically similar civilian community, the mortality rate of Gulf War veterans has been less than one- half the rate observed in the general population during the decade since the war with Iraq.129

For psychological illnesses, clinical and epidemiological studies have found indications of increased rates of depression, post-traumatic stress disorder (PTSD), and stress-related symptomatology among Gulf War veterans compared to non-deployed military personnel.117,119,130,131

A series of fourteen expert panels in the USA have evaluated available clinical and research data on Gulf War health issues but did not identify a unique war-related syndrome."132-139 Additionally, none of the postulated exposure risks has been demonstrated or ruled-out as a cause of illness among widespread groups of Gulf War veterans. The Presidential Advisory Committee on Gulf War Veterans' Illnesses concluded in 1996 that stress is likely to be an important "contributing factor" in the development of the broad range of illnesses experienced by Gulf War veterans.137

A recent Institute of Medicine (IOM) committee evaluated peer-reviewed research on the potential exposures of greatest concern to representatives of Gulf War veterans' organizations: sarin, pyridostigmine bromide (PB), depleted uranium, and the vaccines used to prevent anthrax and botulism. The current scientific literature was evaluated for any evidence of a link between these exposures and long-term health effects. Unfortunately, the IOM committee concluded: "Because little information exists on actual exposure levels -- a critical factor when assessing health effects -- the committee emphasized that it could not draw specific conclusions about the health problems of Gulf War veterans."140,141

Another recent IOM committee came to the following conclusion:

"Several expert committees were asked to examine those various risk factors and to determine whether a ‘unique’ Gulf War illness with a known cause could be established. Each of these panels concluded that there was no evidence consistent with the existence of a unique illness and that no single cause could be established. That remains the case, despite a vigorous research portfolio examining multiple hypotheses put forward as possible explanations for the medically unexplained physical symptoms experienced by these sick veterans. This continuing controversy highlights, in a very visible way, the tensions that exist between expectations and realities, between science and politics, and between policy and execution."142

Since the question arose about a possible "Gulf War syndrome," a number of similar conditions have been reported among war veterans and military peacekeepers, including a Balkan syndrome,143,144 Cambodia syndrome,145 and Chechnya syndrome.146 The repeated occurrence of difficult to explain symptoms among combat troops and military peacekeepers indicate that these health problems are an inherent aspect of hazardous military deployments.147

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