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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature

Committee on the Review of the Scientific Literature on Amyotrophic Lateral Sclerosis in Veterans

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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THE NATIONAL ACADEMIES PRESS

500 Fifth Street, N.W. Washington, DC 20001

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 V101(93)P-1637, Task Order 25 and Task Order 30, between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, or conclusions expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

International Standard Book Number-10: 0-309-10254-5

International Standard Book Number-13: 978-0-309-10254-4

Additional copies of this report are available from the

National Academies Press,

500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624–6242 or (202) 334–3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2006 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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“Knowing is not enough; we apply,

Willing is not we do.”

—Goethe

INSTITUTE MEDICINE OF OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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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. Wm. A.Wulf 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. Wm. A.Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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COMMITTEE ON THE REVIEW OF THE SCIENTIFIC LITERATURE ON AMYOTROPHIC LATERAL SCLEROSIS IN VETERANS

RICHARD T.JOHNSON, MD (Chair), Distinguished Service Professor of Neurology, Microbiology, and Neuroscience,

Johns Hopkins University School of Medicine, Baltimore, MD

WALTER G.BRADLEY, DM, FRCP, Professor and Chair,

Department of Neurology, Miller School of Medicine at the University of Miami, FL

BEATE R.RITZ, MD, PhD, MPH, Professor and Vice Chair,

Department of Epidemiology, University of California, Los Angeles School of Public Health, Los Angeles

WALTER A.ROCCA, MD, MPH, Professor of Epidemiology and Neurology,

Mayo Clinic College of Medicine, Rochester, MN

JEREMY M.SHEFNER, MD, PhD, Professor and Chair,

Department of Neurology, State University of New York, Upstate Medical University, Syracuse

CHRISTINA WOLFSON, PhD, Professor of Epidemiology and Biostatistics,

McGill University, Montreal, Canada

STAFF

ABIGAIL MITCHELL, PhD, Senior Program Officer

MICHAEL SCHNEIDER, MPH, Senior Program Associate

DEEPALI PATEL, Senior Program Associate

PETER JAMES, Research Associate

DAMIKA WEBB, Research Assistant

RENEE WLODARCZYK, Program Assistant

NORMAN GROSSBLATT, Senior Editor

ROSE MARIE MARTINEZ, ScD, Director,

Board on Population Health and Public Health Practice

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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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 wish to thank the following for their review of this report:


CARMEL ARMON, MD, MSC, MHS, Tufts University and Baystate Medical Center, Boston, MA

CARLO DELUCA, PHD, Neuromuscular Research Center, Boston University, MA

LAWRENCE GOLDSTEIN, PHD, Department of Cellular and Molecular Medicine, University of California, San Diego and Howard Hughes Medical Institute

CLIFTON L.GOOCH, MD, EMG Laboratory of New York Presbyterian Hospital and Columbia Neuropathy Research Center, Columbia University College of Physicians and Surgeons, NY

FREYA KAMEL, MD, MPH, National Institute of Environmental Health Sciences, Research Triangle Park, NC

LORENE NELSON, PHD, Department of Health Research and Policy, Stanford University, CA

M.DONALD WHORTON, MD, MPH, Executive Vice President and Epidemiologist, WorkCare, Inc., Alameda, CA


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 this report was overseen by Elena Nightingale, Scholar-in-Residence, Institute of Medicine. Appointed by the National Research Council, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature. Washington, DC: The National Academies Press. doi: 10.17226/11757.
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Amyotrophic lateral sclerosis (ALS) our Lou Gehrig's disease is a fatal, mostly non-familial disease that affects the nervous system of humans by causing the degeneration of nerve cells in the brain and spinal cord. The degeneration halts communication between the nervous system and voluntary muscles in the body. This leads to muscle paralysis and eventually the muscles that aid in breathing are affect; causing respiration to fail. The disease, which affects 20,000-30,000 men and women in the United States at any given time, has no effective treatment; most people with ALS die from respiratory failure within 5 years of the onset of symptoms.

Recent epidemiologic studies report an association between the development of ALS and prior service in the U.S. military. The studies evaluated either veterans of the 1991 Persian Gulf War or veterans who served in the military in the period 1910-1982. Due to these findings, the Department of Veterans Affairs (VA) asked the National Academies to conduct an assessment of the potential relationship between military service and the later development of ALS. The project was assigned to the Institute of Medicine (IOM), which appointed a committee and gave it the task of evaluating the scientific literature on ALS in veterans.

The committee began its work by identifying medical and scientific literature on ALS. PubMed, a database created and managed by the National Library of Medicine. Amyotrophic Lateral Sclerosis in Veterans; Review of the Scientific Literature presents the findings of this committee. The committee reviewed, evaluated, and summarized the scientific literature on ALS in veterans, composed primarily of peer-reviewed, published literature. This report includes the recommendations of the committee.

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