Health Consequences of Service During the Persian Gulf War Recommendations for Research and Information Systems, Executive Summary (1996) / Chapter Skim
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For others, however, a wide range of physical, chemical, and psychological stressors and exposures appear to have had health effects disproportionate to the brevity of active combat and the relatively low combat casualty rate.
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Even without the stress of war, among approximately 697,000 people over a period of several years, there will be poorly understood ailments and a number of obscure diseases. The work of the committee was determined by its charge, which is derived from Section 706 of Public Law 102-585, in which Congress directed the secretaries of DVA and DoD to seek an agreement with the Medical Follow-up Agency of the Institute of Medicine to review existing scientific, medical, and other information on the health consequences of military service in the PG theater of operations during the Persian Gulf War (POW)
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Our overarching themes are that reliable and relevant data are essential, that both the broad and the fine details matter a great deal, and that developing an understanding of the range of uncertainty of a risk assessment, while possibly discomforting, may be of greater importance than highlighting best-guess conclusions. Several good research studies are now under way; attempts are being made to link potential exposures with troop locations; information systems are being improved with regard to data capture (including in-theater tracking)
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In addition, wartime conditions, including measures uniquely designed to protect the troops, necessitated other exposures such as vaccines against possible biological warfare agents, pyridostigmine bromide to protect against possible chemical warfare agents, and pesticides to protect against bites from insects carrying diseases such as sandily fever and leishmaniasis. Depleted uranium, used in munitions and tank armor, was a limited but real wartime exposure.
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Our task is to summarize the data available to date that appear relevant to our charge of examining possible health consequences of PGW service and recommend the nature of future studies that would provide more and better answers to this question. Although medical scientists often can use clinical data and individual reports of health experiences to identify areas of concern, such data and reports cannot in themselves provide proof of cause and effect about the health outcomes of PGW service.
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These studies came to the similar conclusion that troops reported high rates of a variety of nonspecific symptoms, including fatigue, joint pain and stiffness, disturbed or unrefreshing sleep, some gastrointestinal complaints, and a variety of complaints suggestive of mood and musculoskeletal disorders. Thus, although these outbreak studies were successful in demonstrating a common pattern of perceived health problems across a range of military units deployed to the Gulf, they were not successfii} in demonstrating that these symptoms occurred at a higher rate among PGW veterans than among PG-era veterans (those who did not serve in the PG)
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The single most troublesome problem encountered in attempts to conduct epidemiologic studies of illnesses among PGW veterans has been the inability to retrieve information on medical care events such as hospitalizations, outpatient visits, and diagnoses and treatments from DoD and DVA medical records in a uniform and systematic manner. Lack of uniform and retrievable medical information concerning reserve, National Guard, active, and separated forces has greatly inhibited systematic analysis of the health effects of mobilization.
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These changes include creation of a uniform medical record, including data from civilian providers; full implementation of the Defense Medical Epidemiological Database system; and completion of the Army's Patient Accounting and Reporting Real-Time Tracking System (PARRTS) , including expansion to the other branches of service.
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and the putative causal associations that we evaluated demonstrate the vexing nature of the medical problem presented by what some have referred to as a Gulf War Syndrome, and we refer to here as unexplained illnesses (UI)
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The DoD, He branches of He armed services, and the DVA should continue to work together to develop, fund, and staff medical information systems that include a single, uniform, continuous, and retrievable electronic medical record for each service person. The uniform record should include each relevant health item (including baseline personal risk factors, every inpatient and outpatient medical contact, and all health-related interventions)
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Recommendation 4. The DoD should ensure that military medical preparedness for deployments includes detailed attempts to monitor natural and man-made environmental exposures and to prepare for rapid response, early investigation, and accurate data collection, when possible, on physical and natural environmental exposures that are known or possible in the specific theater of operations.
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Recommendation 11. The DoD and DVA should ensure that studies of the health effects of deployment, including effects on POW veterans, include evaluation of the exposures, experiences, and situations of both women and men, with attention to their age, prior military service, marital and parental status, and other gender-specific parameters.
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Recommendation 16. The Congress, DVA, and DoD should adopt a policy that unless there are well-specified, openly stated reasons to the contrary, requests for proposals for research related to unexplained illnesses or other needed health-related research will be publicly announced and open to the scientific community at large, that proposals will be reviewed by panels of appropriately qualified experts, and that funding will follow the recommendations of those experts.
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