Gulf War and Health Volume 10: Update of Health Effects of Serving in the Gulf War, 2016 (2016) / Chapter Skim
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6 Findings and Recommendations
6 Findings and Recommendations
Pages 239-250
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From page 239... ...
have systematically examined the available clinical, epidemiologic, and toxicologic information in efforts to explain the multiple health problems of veterans who served in the 1990–1991 Gulf War. Those health conditions have included a constellation of symptoms, commonly grouped under the label of Gulf War illness.
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Multiple studies found that some Gulf War veterans, regardless of their country of origin and their different deployment-related exposures, have persistent, debilitating, and varying symptoms of Gulf War illness. For several conditions only one study, or in some cases no studies, were of sufficient quality to meet the criteria for a primary study (see Chapter 2 for a description of the criteria for primary and secondary studies)
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From page 241... ...
• Gastrointestinal symptoms consistent with functional gastrointestinal disorders such as irritable bowel syndrome and functional dyspepsia • Chronic fatigue syndrome • Gulf War illness Limited/Suggestive Evidence of an Association • Amyotrophic lateral sclerosis (ALS) • Fibromyalgia and chronic widespread pain • Self-reported sexual difficulties Inadequate/Insufficient Evidence to Determine Whether an Association Exists • Any cancer • Cardiovascular conditions or conditions of the blood and blood-forming organs • Endocrine and metabolic conditions • Neurodegenerative conditions other than ALS • Neurocognitive and neurobehavioral performance • Migraines and other headache disorders • Other neurologic conditions • Respiratory conditions • Structural gastrointestinal conditions • Skin conditions • Musculoskeletal system conditions • Genitourinary conditions • Specific birth defects • Adverse pregnancy outcomes (e.g., miscarriage, stillbirth, preterm birth, and low birth weight)
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. Although there has been a substantial body and a broad basis of research on Gulf War veterans, there are still substantial gaps and limitations in the body of evidence regarding the health effects of deployment to the Gulf War, and Gulf War illness in particular.
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Although the committee determined that Gulf War illness is not a psychosomatic condition, a continuing problem with studying Gulf War illness is that most of the studies have excluded important psychophysiological aspects of the illness with regard to both diagnosis and treatment, in spite of veterans identifying symptoms such as chronic pain and sleep disturbances that may be amenable to psychophysiological therapies, alone or in conjunction with other treatments. Based on available research data, it does not appear that a single mechanism can explain the multitude of symptoms seen in Gulf War illness, and it is unlikely that a single definitive causal agent will be identified this many years after the war.
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R ecommendation: The Department of Veterans Affairs and the Department of Defense should develop a joint and cohesive strategy on incorporating emerging diagnostic technologies and personalized approaches to medical care into sufficiently powered future research to inform studies of Gulf War illness and related health conditions. NEUROLOGICAL CONDITIONS The Volume 10 committee was specifically tasked with assessing the association between deployment to the Persian Gulf region and the prevalence of neurologic conditions, particularly Parkinson's disease, multiple sclerosis, ALS, and migraines.
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LUNG AND BRAIN CANCER The Volumes 8 and 10 committees were asked to specifically consider whether Gulf War veterans were at increased risk for developing any form of brain cancer, a relatively rare cancer. The Volume 4 committee described one mortality study of Gulf War veterans that found an increased risk of dying from brain cancer in deployed veterans through 2000.
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In summary, the Volume 10 committee finds that the evidence continues to be inadequate/insufficient to determine whether deployed Gulf War veterans are at increased risk of developing any cancer, including lung cancer and brain cancer. The relative rarity of cancers such as brain cancer argues for larger studies with adcancer equate statistical power.
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Although many animal studies have attempted to simulate exposure scenarios that mimic possible chemical exposures that occurred during the Gulf War, this has proven to be difficult and the test mixtures and doses are not necessarily representative of the real-world exposures experienced by veterans during deployment. For example, as discussed in Chapter 5, some researchers have developed exposure scenarios for animal models of Gulf War illness that have generally included some combination of sarin, DEET, permethrin, paraoxon, and chlorpyrifos, with a physical stressor such as heat or forced swimming.
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For example, Hispanic and black Gulf War veterans reported increased rates of PTSD, major depressive disorder, and Gulf War illness (Coughlin et al., 2011b) , as well as neurological conditions and multiple sclerosis (Wallin et al., 2012)
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Overall, the committee concludes that, to date, studies of Gulf War veterans have not adequately considered sex- and race/ethnicity-specific health conditions. R ecommendation: Sex-specific and race/ethnicity-specific health conditions should be deter mined and reported in future studies of Gulf War veterans.
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