Chronic Multisymptom Illness in Gulf War
Veterans: Case Definitions Reexamined
Committee on the Development of a Consensus Case Definition for Chronic
Multisymptom Illness in 1990–1991 Gulf War Veterans
Board on the Health of Select Populations
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
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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 VA240-13-D-0024 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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IOM (Institute of Medicine). 2014. Chronic Multisymptom Illness in Gulf War Veterans: Case Definitions Reexamined. Washington, DC: The National Academies Press.
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OF THE NATIONAL ACADEMIES
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COMMITTEE ON THE DEVELOPMENT OF A CONSENSUS CASE DEFINITION FOR CHRONIC MULTISYMPTOM ILLNESS IN 1990–1991 GULF WAR VETERANS
KENNETH SHINE (Chair), Special Adviser to the Chancellor, University of Texas, Austin, TX
FLOYD E. BLOOM, Professor Emeritus, Molecular and Integrative Neuroscience Department, The Scripps Research Institute, LaJolla, CA
KARON FRANCES COOK, Research Associate Professor, Northwestern University Feinberg School of Medicine, Chicago, IL
DEBORAH A. CORY-SLECHTA, Professor, Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY
FRED FRIEDBERG, Research Associate Professor, Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY
JOANNA G. KATZMAN, Director, University of New Mexico Pain Center and Associate Professor, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM
HOWARD M. KIPEN, Professor of Environmental and Occupational Medicine and Chief, Clinical Research and Occupational Medicine Division, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ
JEANNIE-MARIE S. LEOUTSAKOS, Assistant Professor, Director, Psychiatry Biostatistics and Methodology Core, Johns Hopkins University School of Medicine, Baltimore, MD
JAMES L. LEVENSON, Professor of Psychiatry, Internal Medicine and Surgery, Virginia Commonwealth University, Richmond, VA
CATHERINE LOMEN-HOERTH, Director, ALS Center, Professor of Neurology, University of California, San Francisco, Medical Center, San Francisco, CA
THOMAS J. MASON, Professor, Department of Environmental and Occupational Health, College of Public Health, Department of Internal Medicine, College of Medicine, University of South Florida, Tampa, FL
LINDA ANH B. NGUYEN, Clinical Assistant Professor, Director, GI Motility and Neurogastroenterology, Stanford University, Palo Alto, CA
F. JAVIER NIETO, Helfaer Professor of Public Health, Professor of Population Health Sciences and Family Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI
ANNE LOUISE OAKLANDER, Associate Professor of Neurology, Harvard Medical School, Assistant in Pathology (Neuropathology), Massachusetts General Hospital, Boston, MA
RON F. TEICHMAN, Teichman Occupational Health Associates, Inc., West Orange, NJ
SUZANNE D. VERNON, Scientific Director, The CFIDS Association of America, Charlotte, NC
IOM Staff
CAROLYN FULCO, Scholar
RENEE WLORDCZYK, Associate Program Officer (until August 2013)
CARY HAVER, Associate Program Officer
NORMAN GROSSBLATT, Senior Editor
JOSEPH GOODMAN, Senior Program Assistant
SULVIA DOJA, Senior Program Assistant
DORIS ROMERO, Financial Associate
FREDERICK ERDTMANN, Director, Board on the Health of Select Populations
Consultants
MIRIAM DAVIS, Independent Consultant, Silver Spring, MD
ANDREW KAYSER, Ernest Gallo Clinic & Research Center, University of California, San Francisco, San Francisco, CA
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 thank the following for their review of this report:
John C. Bailar, University of Chicago
Dan G. Blazer, Duke University Medical Center
Kenneth W. Kizer, University of California Davis
David Korn, Harvard University
Kurt Kroenke, Indiana University School of Medicine
Eric B. Larson, Group Health Research Institute
Stephen R. Mitchell, Georgetown University School of Medicine
Rebecca Nugent, Carnegie Mellon University
Tyler Smith, National University
Simon Wessely, Kings College London
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 the report was overseen by Huda Akil, University of Michigan, and Harold C. Sox, Dartmouth Institute for Health Policy and Clinical Practice. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the author committee and the institution.
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Contents
How the Committee Approached Its Charge
Addressing Chronic Multisymptom Illness in Gulf War Veterans
3 STUDIES OF SYMPTOMS IN GULF WAR VETERANS
General Limitations of Gulf War Studies
4 FACTOR ANALYSIS AND ITS USE IN STUDIES OF SYMPTOMS IN GULF WAR VETERANS
5 CHRONIC MULTISYMPTOM ILLNESS CASE DEFINITIONS AND RECOMMENDATIONS
Discussion of Existing Case Definitions
Considerations for Future Research
A ADDITIONAL INFORMATION ABOUT FACTOR ANALYSIS AND CLUSTER ANALYSIS
B PERCENTAGES OF VETERANS REPORTING SYMPTOMS IN STUDIES OF GULF WAR VETERANS AND MILITARY PERSONNEL
