Summary of conclusions of workshop following 1.5 days of
presentations, testimony by veterans, and questions and discussion. Panel
responded to following key questions:
1. What is the evidence for an increased incidence of
unexpected illnesses attributable to service in the Persian Gulf War?
Panel defined unexpected illnesses as previously unrecognized and unanticipated
symptom complexes or illnesses that do not fit traditional diagnostic
categories. Available data are too limited to draw any conclusions about
the incidence of unexpected illnesses. Lacking are data that individuals
reporting symptoms are representative of all persons at risk for developing
these symptoms. Nevertheless, available data suggest that deployed personnel
report more symptoms than those who did not deploy and veterans of previous
wars.
2. If unexpected illnesses have occurred, what are the
components of the most practical working case definition(s) based on existing
data? It is impossible at this time to establish a single case definition.
To achieve such a case definition, evaluations of PG veterans and comparison
groups should be carried out.
3. If unexpected illnesses have occurred, what are the
plausible etiologies and biological explanations for these unexpected
illnesses? No single or multiple etiology or biological explanation
for the reported symptoms was identified from the data available to the
panel. Possible causative or contributing factors discussed were: leishmaniasis,
petroleum vapors, solvents, and combustion products, sand/dust, depleted
uranium, pyridostigmine, pesticides, chemical agent-resistant coatings,
biological and chemical war agents, vaccines, and various stressors.
4. What future research is necessary? A more accurate
estimate of symptom prevalence should be established through questionnaires
of all GW veterans or of a representative sample. Departments of Veterans
Affairs (DVA) and Defense (DoD) should develop and apply a coordinated,
uniform case assessment protocol for diagnosis and treatment. Symptom
rates should be compared among personnel deployed to the Gulf, deployed
elsewhere, and not deployed, using both cohort studies and case-control
studies. Pulmonary function should be evaluated among those exposed to
oil fire plumes. Studies should simulate and model indoor exposures associated
with heaters, petroleum, insecticides, and spray painting. Studies should
investigate the relationship of stressors of deployment and combat to
the symptoms afflicting some GW veterans. The DVA should develop more
effective approaches to diagnosis and therapy of veterans affected by
stress-related or stress-exacerbated illness. DoD should develop plans
for prompt collection of high-quality data for future deployments, including
baseline health status, environmental exposures during deployments, and
health status both before and after deployments. Research should be conducted
to facilitate more sensitive means of diagnosis of viscerotropic leishmaniasis
and apply such screening to veterans with unexplained illness. |