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Date: Sept. 12, 2006
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FOR IMMEDIATE RELEASE
GULF WAR VETERANS EXPERIENCE HEALTH SYMPTOMS, BUT NOT UNIQUE SYNDROME;
ELEVATED RATES OF ALS, PSYCHOLOGICAL CONDITIONS FOUND
WASHINGTON -- Although veterans of the first Gulf War report significantly more symptoms of illness than soldiers of the same period who were not deployed, studies have found no cluster of symptoms that constitute a syndrome unique to Gulf War veterans, says a new report from the Institute of Medicine. However, evidence shows that service in the Persian Gulf during the 1990-1991 conflict places veterans at increased risk for developing anxiety disorders, depression, and substance-abuse problems, said the committee that wrote the report. In addition, it found evidence that suggests there may be an elevated rate of the rare disorder amyotrophic lateral sclerosis (ALS) among Gulf War veterans.
Researchers lack data needed to determine whether many long-term health problems are associated with service in the Gulf War because there were inadequate screenings and medical exams before deployment and only limited examinations of returning personnel. Pre-deployment screenings would have established a baseline for comparing health status after deployment. The report endorses a policy of appropriate pre- and post-deployment medical screening of military personnel.
The report also calls for improved monitoring of exposure to contaminants in the field. There was almost no direct monitoring of Gulf War soldiers’ exposures to contaminants, and therefore it might never be possible to pinpoint if an exposure during their service might be associated with an illness, the committee noted. Reports indicate that personnel were potentially exposed to sarin gas, pesticides, air pollutants, vaccines, solvents, and pharmaceuticals. However, most estimates of exposure are based on self-reporting, which is subjective, and on models that are uncertain because of inadequate monitoring data.
“Gulf War veterans consistently report experiencing a wide range of symptoms, and this the case for both American veterans and military personnel from Canada, Australia, and other countries who served in the Persian Gulf,” said committee chair Lynn Goldman, professor of occupational and environmental health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. “But because the symptoms vary greatly among individuals, they do not point to a syndrome unique to these veterans. Unfortunately, because of the lack of objective pre-deployment health information, we do not have the baseline data needed to draw more definitive conclusions about many aspects of these veterans’ long-term health.”
The committee identified three studies that indicate a possible association between Gulf War service and increased risk for developing ALS, a rare disorder that occurs in five of every 100,000 people in the general population. To date there is no evidence that overall rates of cancer are increased in Gulf War veterans, but some evidence points to a possible association between service and brain cancer. “Because ALS occurs so rarely, any individual veteran’s chances of developing the disease are still generally low,” Goldman said. “Although the reports linking Gulf War service to ALS and brain cancer are inconclusive at this time, we do recommend follow-up studies to monitor rates of these diseases in Gulf War veterans,” she added.
In addition to increased chances of experiencing a psychological condition such as depression, anxiety, or post-traumatic stress disorder (PTSD), Gulf War veterans also were more likely to sustain transportation-related injuries or deaths in the first few years upon return from the war, but not in later years, the committee found. These findings are consistent with studies of personnel who served in other armed conflicts in which higher rates of PTSD and motor vehicle fatalities were reported in the years following service.
The committee reviewed 850 relevant studies, some of which relied on self-reporting of symptoms from veterans, and others that used objective measures of symptoms and exposures. The cumulative evidence from studies that relied on veterans’ self-reports indicates that almost 30 percent of Gulf War veterans have experienced a multisymptom illness compared with 16 percent of nondeployed personnel, the report notes. This was true not only for U.S. veterans but also service members from other countries who served in the Persian Gulf.
Many studies based on self-reports by Gulf War veterans have found a higher prevalence of symptoms such as fatigue, memory loss, muscle and joint pain, and difficulties sleeping, symptoms that are among those associated with the chronic, multisymptom conditions fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity. Not surprisingly, studies find higher rates of chronic, multisymptom illnesses among Gulf War veterans as well. There are no objective diagnostic tests available to validate these self-reported disorders.
Rates of hospitalization were similar among deployed and non-deployed veterans, and studies do not support an increased risk of peripheral neuropathy or cardiovascular disease. Some studies found elevated rates of birth defects in babies born to those who served in the Persian Gulf, but the patterns were inconsistent. The evidence also is inconsistent about whether service increased veterans’ risk of respiratory illness, although there are studies that have found a link between exacerbation of asthma and exposure to smoke from oil-well fires.
The study was sponsored by the U.S. Department of Veterans Affairs. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.
Pre-publication copies of GULF WAR AND HEALTH, VOLUME 4: HEALTH EFFECTS OF SERVING IN THE GULF WAR are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at HTTP://WWW.NAP.EDU. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
[This news release and report are available at HTTP://NATIONAL-ACADEMIES.ORG
INSTITUTE OF MEDICINE
Board on Population Health and Public Health Practice
COMMITTEE ON GULF WAR AND HEALTH: REVIEW OF THE MEDICAL
LITERATURE RELATIVE TO GULF WAR VETERANS' HEALTH
LYNN R. GOLDMAN, M.D., M.P.H. (CHAIR)
Bloomberg School of Public Health
Johns Hopkins University
MARCIA ANGELL, M.D.
Department of Social Medicine
Harvard Medical School
W. KENT ANGER, PH.D.
Associate Director for Occupational Research and Health Promotion
Center for Research on Occupational and Environmental Toxicology
Oregon Health and Science University
MICHAEL BRAUER, SC.D.
School of Occupational and Environmental Hygiene
University of British Columbia
Vancouver, British Columbia
DEDRA S. BUCHWALD, M.D.
Associate Professor of Medicine
Harborview Medical Center
University of Washington
FRANCESCA DOMINICI, PH.D.
Bloomberg School of Public Health
Johns Hopkins University
ARTHUR L. FRANK, M.D., PH.D.
Professor and Chair
Department of Environmental and Occupational Health
Drexel University School of Public Health
FRANCINE LADEN, SC.D.
Assistant Professor of Medicine
Harvard Medical School
DAVID MATCHAR, M.D.
Center for Clinical Health Policy Research
Duke University Medical Center
SAMUEL J. POTOLICCHIO, M.D.
Department of Neurology
George Washington University Medical Center
THOMAS G. ROBINS, M.D., M.P.H.
Department of Environmental Health Sciences
University of Michigan School of Public Health
GEORGE W. RUTHERFORD, M.D.
Division of Preventive Medicine and Public Health
School of Medicine
University of California
CAROL TAMMINGA, M.D.
Department of Psychiatry
University of Texas Southwestern Medical Center
CAROLYN FULCO, M.S.