Gulf War and Health Volume 8: Update of Health Effects of Serving in the Gulf War (2010) / Chapter Skim
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5 CONCLUSIONS AND RECOMMENDATIONS
5 CONCLUSIONS AND RECOMMENDATIONS
Pages 255-264
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From page 255... ...
In preparing this report, the Update committee modified the health outcomes that were reviewed in Volume 4. For example, the Update committee included genitourinary outcomes, considered multisymptom illness as a separate entity rather than using the ICD category of "symptoms, signs, and abnormal clinical and laboratory findings," and did not include multiple chemical sensitivity or chronic fatigue syndrome as separate outcomes, but rather considered them as multisymptom illnesses.
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From page 256... ...
It considered studies that used only self-reports by Gulf War veterans to be secondary studies for most health outcomes; the major exception to this rule was multisymptom illness. However, some health outcomes, such as fibromyalgia or irritable bowel syndrome, lack objective diagnostic tests and are diagnosed based on symptom reporting that meet accepted criteria (for example, the Centers for Disease Control and Prevention criteria for chronic fatigue syndrome and the Rome criteria for irritable bowel syndrome)
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From page 257... ...
Inadequate/Insufficient Evidence to Determine Whether an Association Exists The available studies are of insufficient quality, validity, consistency, or statistical power to permit a conclusion regarding the presence or absence of an association between deployment to the Gulf War and a health outcome in humans. • Any cancers.
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From page 258... ...
As a result uncertainty remains concerning the relationship between deployment to the Gulf War and health outcomes. These limitations include: ° Lack of representativeness of the Gulf War population in some studies, affecting external validity such that what we have learned from the samples studied cannot be easily extrapolated to all Gulf War veterans.
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From page 259... ...
Shinseki to invite representatives of the VA Research Advisory Committee on Gulf War Veterans' Illnesses (RAC) to make presentations to the committee on the findings and conclusions in its report, Gulf War Illness and the Health of Gulf War Veterans, released in November 2008, to "ensure that the basis for any differences between these reports can be efficiently and accurately communicated and considered by the latest IOM committee." The Update committee concluded, based on a comprehensive review of the human epidemiologic literature, that there is sufficient evidence of an association between deployment to the Gulf War and multisymptom illness (see Chapter 4)
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From page 260... ...
How does predeployment health status influence the risk of developing Gulf War illness? Why do some veterans suffer a constellation of many symptoms whereas others experience isolated symptoms or only some components of the illness, and still others who served in the same battleground seemingly with similar exposures remain entirely without symptoms?
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From page 261... ...
Given the high reported prevalence of persistent symptoms, plus the steady advances in understanding genetics, molecular diagnostics, and imaging, it is possible now to plan and carry out adequately powered studies to identify inherited genetic variants, molecular profiles of gene expression, other epigenetic markers (such as modifications of DNA structure related to environmental exposures) , specific viral exposures, signatures of immune activation, or brain changes identified by sensitive imaging measures -- all these are traits that distinguish Gulf War veterans with persistent medical symptoms from healthy deployed or nondeployed veterans.
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From page 262... ...
• Validate reported biomarkers of Gulf War illness, including anatomic and functional imaging findings and published immune associations. • There is a dearth of organized clinical trials to examine potential treatments for the observed symptoms experienced by Gulf War veterans.
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From page 263... ...
CONCLUSIONS AND RECOMMENDATIONS 263 creating an adequately powered dataset and then encouraging practical and innovative science aimed at understanding the basis of unexplained symptoms in Gulf War veterans and developing effective treatments in order to alleviate their suffering as rapidly and completely as possible.
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