Gulf War Illness and the Health of Gulf War Veterans Scientific ...

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Research Advisory Committee on Gulf War Veterans’ Illnesses U.S. Department of Veterans Affairs Washington, D.C. website: www.va.gov/RAC-GWVI Committee Staff Office: Research Advisory Committee on Gulf War Veterans’ Illnesses Boston University School of Public Health 715 Albany Street (T-4W) Boston, MA 02118 email: RAC@bu.edu
Gulf War Illness and the Health of Gulf War Veterans Table of Contents Findings in Brief…………………………………………………………………………………..………………………...… 1 Executive Summary………….………………………………………………………………….…………………………... 3 Introduction………………………………………………………………………..……………………………………….….. 19 1| Gulf War Illness and the Health of Gulf War Veterans…………………………………………... 23 Characteristics and impact of Gulf War illness: Epidemiologic research …………………………………. – How many Gulf War veterans have Gulf War illness......................................................................... – Characteristics of Gulf War illness…………………………………………………………………………… – Which veterans are most affected by Gulf War illness...................................................................... – Evaluating causal factors in Gulf War illness ….………………………………………………………….. 25 25 27 31 32 Gulf War illness prognosis and the need for treatments ……………………............................................. – Are veterans with Gulf War illness getting better or worse with time............................................. – The urgent need for effective treatments for Gulf War illness…………………………………………. 36 36 36 Is there a unique Gulf War Syndrome........................................................................................................ 41 Other Gulf War health issues ……………………………………………………………………………………… – Diagnosed diseases affecting Gulf War veterans…..…………………………………………………….. – Mortality rates among Gulf War veterans…………….…………………………………………………….. – Hospitalization rates among Gulf War veterans…………………………………………………………... – Birth defects and the health of Gulf War veterans’ family members………………………………….. 43 43 47 48 49 Special committee and government reports on the health of Gulf War veterans…………..…………….. 53 Recommendations……………………………………………………………………………………….…………… 56 2| What Caused Gulf War Illness Effects of Gulf War Experiences and Exposures.. 59 Psychological stressors and the health of Gulf War veterans.……………………..................................... – Traumatic experiences and psychological stressors in the Gulf War…………………………………. – Health effects of psychological stressors………………………………………………………………….. – Research on the health of Gulf War veterans in relation to psychological stressors…………….... – Recommendation……………………………………………………………………………………….............. 61 62 63 66 74 Kuwaiti oil well fires and the health of Gulf War veterans……………………………………………………. – Exposure to oil well fires and smoke during Gulf War deployment…………………………………… – Health effects of Kuwaiti oil fire-related exposures……………………………………………………… – Studies evaluating the health of Gulf War veterans in relation to the Kuwaiti oil fires……………. – Recommendations……………………………………………………………………………………………… 75 75 79 80 84 Depleted uranium and the health of Gulf War veterans……………………................................................. 85 – Depleted uranium exposure in the Gulf War……………………………………………………………….. 86 – Health effects of DU exposure………………………………………………………………………………… 87 – Research on the health of Gulf War veterans in relation to DU exposure……………………………. 95 – Recommendations………………………………………………………………………………………………. 100 Table of Contents • i
Page 1: Gulf War Illness and the Health of
Page 4 and 5: Research Advisory Committee on Gulf
Page 8 and 9: Table of Contents 2| What Caused Gu
Page 10 and 11: Table of Contents Appendices Append
Page 12 and 13: Gulf War illness is associated with
Page 14 and 15: described throughout the report, sc
Page 16 and 17: Other Health Issues Affecting Gulf
Page 18 and 19: evidence that exposure to oil fire
Page 20 and 21: epellants, sarin, and stress, at do
Page 22 and 23: specialized SPECT scan analyses. In
Page 24 and 25: amounts of PON1 differ, sometimes d
Page 26 and 27: The Committee identified major prob
Page 28 and 29: 18 • Gulf War Illness and the Hea
Page 30 and 31: health problems have been the subje
Page 32 and 33: psychological stress of war to the
Page 34 and 35: e studied as a “multisymptom illn
Page 36 and 37: Table 1. Prevalence of Multisymptom
Page 38 and 39: Table 2. Symptom Domains Affecting
Page 40 and 41: likely to report a number of other
Page 42 and 43: indicate that Gulf War illness did
Page 44 and 45: Table 3. Effects of Confounding by
Page 46 and 47: Gulf War Illness Prognosis and the
Page 48 and 49: improvement on veterans’ SF36 PCS
Page 50 and 51: was provided for Committee review i
Page 52 and 53: Research studies have not supported
Page 54 and 55: deployment. This excess could be of
Page 56 and 57:
have asked veterans to report if th
Page 58 and 59:
A number of theories have been put
Page 60 and 61:
children born to male Gulf War vete
Page 62 and 63:
The long-anticipated results of thi
Page 64 and 65:
affect Gulf War veterans at excess
Page 66 and 67:
Recommendations Despite the brief d
Page 68 and 69:
Operation Desert Storm: Summary of
Page 70 and 71:
The Committee used a standardized a
Page 72 and 73:
The word “stress” is used in a
Page 74 and 75:
War and the subsequent development
Page 76 and 77:
Taken together, human and animal st
Page 78 and 79:
The lack of association between com
Page 80 and 81:
Table 4. Prevalence of Post Traumat
Page 82 and 83:
Other studies have reported both hi
Page 84 and 85:
Recommendation Evidence from multip
Page 86 and 87:
winds helped to rapidly dissipate t
Page 88 and 89:
Overall, results from environmental
Page 90 and 91:
after ignition of the oil wells. Ac
Page 92 and 93:
to the risk of developing Gulf War
Page 94 and 95:
Recommendations Based on available
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About 320 tons of DU was used durin
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adiological and chemical effects. 1
Page 100 and 101:
Table 1. Health Effects of Depleted
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Table 2. Brain and Behavioral Effec
Page 104 and 105:
Table 3. Genotoxic, Mutagenic, and
Page 106 and 107:
problems reported by Canadian Gulf
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example, prolactin levels were sign
Page 110 and 111:
Recommendations Preliminary evidenc
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Table 1. Vaccines Routinely Given t
Page 114 and 115:
shots in theater, in January and Fe
Page 116 and 117:
effects from receiving multiple vac
Page 118 and 119:
Accounting Office (GAO, now the Gov
Page 120 and 121:
Table 4. Studies Identifying Rates
Page 122 and 123:
Table 5. Studies Assessing Longer-t
Page 124 and 125:
an arthralgia-related multisymptom
Page 126 and 127:
The squalene controversy has been m
Page 128 and 129:
vaccine formulation, and concluded
Page 130 and 131:
Although squalene has been the prim
Page 132 and 133:
observation period, with improved s
Page 134 and 135:
differed from those administered pr
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current use is the same as that of
Page 138 and 139:
Cholinergic and Related Neurotoxica
Page 140 and 141:
Pyridostigmine bromide (PB) use in
Page 142 and 143:
Table 2. Pesticides and Insect Repe
Page 144 and 145:
Although comprehensive information
Page 146 and 147:
Committee broadly reviewed informat
Page 148 and 149:
more significant symptoms and signs
Page 150 and 151:
agent as a result. But based on rou
Page 152 and 153:
Questions about Khamisiyah models a
Page 154 and 155:
Figure 2. Iraqi Chemical Weapons Fa
Page 156 and 157:
use of chemical agents during the G
Page 158 and 159:
even at higher doses. Additional ef
Page 160 and 161:
sweating. Symptoms are reported by
Page 162 and 163:
vulnerability to adverse effects of
Page 164 and 165:
Civilian use DEET formulations typi
Page 166 and 167:
disease and exposure to pesticides
Page 168 and 169:
The IOM committee also found that e
Page 170 and 171:
Table 4. Studies Evaluating Persist
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very high, only rats with the high
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In 1979, investigators from Harvard
Page 176 and 177:
central nervous system effects, in
Page 178 and 179:
Table 5. Effects of Combined Gulf W
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Table 6. Animal Studies Evaluating
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and up to 60 days in different stud
Page 184 and 185:
clinical research unit, subjects we
Page 186 and 187:
At 16 weeks, brain acetylcholine le
Page 188 and 189:
veterans with PB, pesticides, and v
Page 190 and 191:
The Committee has reviewed results
Page 192 and 193:
exposures. Although subject to conf
Page 194 and 195:
and healthcare utilization are simi
Page 196 and 197:
Recommendations During the 1990-199
Page 198 and 199:
endemic to the region and/or those
Page 200 and 201:
positive antibody titers to this vi
Page 202 and 203:
The most informative research of th
Page 204 and 205:
Table 3. Post-War Assessment of Inf
Page 206 and 207:
this activation may have resulted f
Page 208 and 209:
Anthrax causes an acute and serious
Page 210 and 211:
Recommendations Because of unanswer
Page 212 and 213:
that, during the months that oil fi
Page 214 and 215:
neurological and cardiovascular eff
Page 216 and 217:
fires and tent heaters. During the
Page 218 and 219:
control blowing sand, which may hav
Page 220 and 221:
eport indicated that of the approxi
Page 222 and 223:
Other Potential Hazards Encountered
Page 224 and 225:
Recommendations A number of exposur
Page 226 and 227:
evidence of an association was stro
Page 228 and 229:
of reasons, including the well-reco
Page 230 and 231:
findings to the Gulf War experience
Page 232 and 233:
Table 2. Gulf War Illness in Relati
Page 234 and 235:
Overview of the Evidence Linking Gu
Page 236 and 237:
War illness and low-level nerve age
Page 238 and 239:
228 • Effects of Gulf War Experie
Page 240 and 241:
Biological and Clinical Characteris
Page 242 and 243:
Brain and Central Nervous System Al
Page 244 and 245:
Table 2. Published EEG and Brain Im
Page 246 and 247:
The Committee also reviewed prelimi
Page 248 and 249:
Table 4. Neurocognitive Evaluation
Page 250 and 251:
Table 5. Neurocognitive Evaluation
Page 252 and 253:
As previously described, VA investi
Page 254 and 255:
Table 4. Published Studies of Auton
Page 256 and 257:
Many of the research limitations de
Page 258 and 259:
Table 7. Studies Assessing Sensory
Page 260 and 261:
In several recently-reported studie
Page 262 and 263:
Five of the six Gulf War projects i
Page 264 and 265:
Overall, differences between studie
Page 266 and 267:
BChE projects, was that mean BChE a
Page 268 and 269:
Table 7. Immune Evaluation of Gulf
Page 270 and 271:
specifically at T cell responses to
Page 272 and 273:
symptomatic Gulf War veterans were
Page 274 and 275:
Table 10. Clinical Findings in Symp
Page 276 and 277:
Genetic findings in symptomatic Gul
Page 278 and 279:
In attempting to understand the bio
Page 280 and 281:
Multisymptom illness associated wit
Page 282 and 283:
widespread pain, cognitive difficul
Page 284 and 285:
Gulf War Illness in Relation to Mul
Page 286 and 287:
Table 1. Prevalence of Fatigue and
Page 288 and 289:
ate of FM among family members of F
Page 290 and 291:
eported that MCS patients have sign
Page 292 and 293:
Research findings in multisymptom c
Page 294 and 295:
e common to both CFS and Gulf War i
Page 296 and 297:
Most notably, a burgeoning number o
Page 298 and 299:
Recommendations Research studies ha
Page 300 and 301:
Historical Funding and Management o
Page 302 and 303:
Since 2002, VA has sponsored a stea
Page 304 and 305:
Table 2. Examples of Psychiatric an
Page 306 and 307:
treating Gulf War illness, on long-
Page 308 and 309:
connection with the Gulf War. They
Page 310 and 311:
from the portfolio of studies ident
Page 312 and 313:
available, potentially promising tr
Page 314 and 315:
ecent data that characterize VA hea
Page 316 and 317:
The WRIISCs were established both t
Page 318 and 319:
Congressional actions have brought
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310 • Research Priorities and Rec
Page 322 and 323:
Research to identify specific patho
Page 324 and 325:
Other Research Areas of Importance
Page 326 and 327:
316 •
Page 328 and 329:
Ms. Angela Newbold, Mr. Kevin Smith
Page 330 and 331:
September 19-21, 2005 (Washington,
Page 332 and 333:
September 15-16, 2008 (Washington,
Page 334 and 335:
21. Abu-Qare AW, Abou-Donia MB. Det
Page 336 and 337:
73. Assefi NP, Sherman KJ, Jacobsen
Page 338 and 339:
126. Benmoyal-Segal L, Vander T, Sh
Page 340 and 341:
181. Brown VJ. Battle scars: global
Page 342 and 343:
238. Cheng Y-S. Chemical compositio
Page 344 and 345:
295. Crofford LJ, Rowbotham MC, Mea
Page 346 and 347:
349. Dockery DW, Behbehani J, Fay M
Page 348 and 349:
404. Engel CC, Hyams KC, Scott K. M
Page 350 and 351:
460. Friedman A, Kaufer D, Shemer J
Page 352 and 353:
512. Grabenstein JD. Drug interacti
Page 354 and 355:
567. Haley RW, Maddrey AM, Gershenf
Page 356 and 357:
620. Holmes DT, Tariot PN, Cox C. P
Page 358 and 359:
676. Institute of Medicine. Health
Page 360 and 361:
732. Joy RM, Walby WF, Stark LG, Al
Page 362 and 363:
786. Kellner M, Baker DG, Yehuda R.
Page 364 and 365:
836. Krengel M, Sullivan K. Neurops
Page 366 and 367:
890. Lestaevel P, Houpert P, Bussy
Page 368 and 369:
945. Mach M, Grubbs RD, Price WA, N
Page 370 and 371:
999. McDiarmid MA, Squibb K, Engelh
Page 372 and 373:
1052. Miranda ML. Spatial analysis
Page 374 and 375:
1107. Nemmar A, Hoet PH, Vanquicken
Page 376 and 377:
1161. Ottenweller JE. Paraoxonase A
Page 378 and 379:
1215. Pittman PR, Kim-Ahn G, Pifat
Page 380 and 381:
1273. Research Working Group of Mil
Page 382 and 383:
1329. Russell IJ. Abnormal T cell s
Page 384 and 385:
1382. Seidel MF, Weinreich GF, Stra
Page 386 and 387:
1433. Smith TC, Gray GC, Weir JC, H
Page 388 and 389:
1486. Stevens D, Scott EA, Bowditch
Page 390 and 391:
1539. Tian H, Song X, Bressler J, P
Page 392 and 393:
1586. U.S. Army Environmental Hygie
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and Risk Characterization of U.S. D
Page 396 and 397:
1679. U.S. General Accounting Offic
Page 398 and 399:
1730. Vojdani A. Scientific reality
Page 400 and 401:
1786. Wijeratne C, Hickie I, Davenp
Page 403:
| Appendices
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396 • Results from Studies of Gul
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438 • Research Advisory Committee
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other information sources it finds
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442 • Research Advisory Committee
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Joel C. Graves, DMin Rev. Graves is
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446 • Gulf War Illness and the He
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448 • Gulf War Illness and the He
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corr correlation CPAP Continuous Po
Page 462 and 463:
MCS MDA MDPH 2ME MEG MF59 MHPG MOD
Page 464:
Th2 TNF TSPs U.K. U.N. UNSCOM USACH
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