WASHINGTON – Although more than $500 million in federally funded research on Persian Gulf War veterans between 1994 and 2014 has produced many findings, there has been little substantial progress in the overall understanding of the health effects, particularly Gulf War illness, resulting from military service in the war, says a new report from the Institute of Medicine (IOM) of the National Academies of Sciences, Engineering, and Medicine. Aligning with conclusions in a 2010 IOM report, the committee that carried out the latest study said veterans who were deployed to the Gulf War appear to have an increased risk for Gulf War illness, chronic fatigue syndrome, functional gastrointestinal conditions, and mental health disorders such as post-traumatic stress disorder, generalized anxiety disorder, depression, and substance abuse. There is some evidence that service during the conflict is linked to amyotrophic lateral sclerosis (ALS), fibromyalgia, chronic widespread pain, and self-reported sexual difficulties, but the data are limited.
For the latest study, the U.S. Department of Veterans Affairs requested that the Academies review, evaluate, and summarize the available scientific and medical literature regarding health effects in veterans of the 1990-1991 Gulf War, paying particular attention to neurological disorders, cancer, and Gulf War illness.
ALS was the only neurologic disease for which the committee found some evidence for an association with deployment in the Gulf War. The committee said the Gulf War veteran population is still young with respect to the development of other neurodegenerative diseases. Therefore, the effects of deployment on the incidence and prevalence may not yet be obvious. The committee recommended that the VA should continue to conduct follow-up assessment of Gulf War veterans for neurodegenerative diseases that have long latencies and are associated with aging, such as ALS, Alzheimer's disease, and Parkinson's disease.
The committee found inadequate or insufficient evidence to determine whether deployed Gulf War veterans are at increased risk of having any cancer, including lung and brain cancer. The VA should conduct further assessments of cancer incidence, prevalence, and mortality because of the long latency of some cancers, the committee said. However, to be informative, future studies also need to account for additional factors, especially smoking.
Although the evidence base for Gulf War illness has increased over the past few years, little new information has increased understanding of the disease or how to effectively treat or manage it. 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 a definitive causal agent or agents can ever be identified, especially this many years after the war, the committee said. Animal studies that attempt to mirror Gulf War illness have been of minimal use because it is difficult to establish experimental exposures that are representative of those experienced by Gulf War veterans during deployment.
Taking into account the findings from this and previous IOM Gulf War and Health reports, the committee concluded that the health conditions associated with Gulf War deployment are primarily mental health disorders and functional medical disorders and that these associations emphasize the interconnectedness of the brain and body. All these conditions have no objective medical diagnostic tests and are diagnosed on the basis of subjective symptom reporting. The committee said research efforts should move forward and be realigned to focus on the treatment and management of Gulf War illness rather than its causes. This realignment should recognize and incorporate the new research on the relationship between the brain and physical functioning to improve the treatment and management options for veterans who have Gulf War illness.
The study by the Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine was sponsored by the U.S. Department of Veterans Affairs. The Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. For more information, visit http://national-academies.org. A roster follows.
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Pre-publication copies of Gulf War and Health, Volume 10: Update of Health Effects of Serving in the Gulf War are available from the National Academies Press on the Internet at http://www.nap.edu or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
THE NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND MEDICINE
Institute of Medicine
Board on the Health of Select Populations
Committee on Gulf War and Health, Volume 10:
Update of Health Effects Serving in the Gulf War
Deborah A. Cory-Slechta, M.A., Ph.D. (chair)
Department of Environmental Medicine
School of Medicine and Dentistry
University of Rochester
Robert H. Brown Jr., M.D., D.Phil.*
Professor and Chair
Department of Neurology and
Director, Day Neuromuscular Research Laboratory
University of Massachusetts Medical School,
Alberto Caban-Martinez, D.O.
University of Miami Miller School of Medicine, and
Associate Director, Miami Occupational Research Group
Javier I. Escobar, M.D.
Associate Dean for Global Health, and
Professor of Psychiatry and Family Medicine
University of Medicine and Dentistry of New Jersey–
Robert Wood Johnson Medical School
Scott Fishman, M.D.
Professor of Anesthesiology,
Chief of the Division of Pain Medicine, and
University of California, Davis Health System
Mary A. Fox, Ph.D., M.P.H.
Department of Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
Herman Gibb, Ph.D.
Gibb Epidemiology Consulting, LLC
Rogene F. Henderson, Ph.D.
Senior Biochemist and Toxicologist Emeritus
Experimental Toxicology Program
Lovelace Respiratory Research Institute
Clifford R. Jack Jr., M.D.*
Professor of Radiology and the Alexander Family Professor of Alzheimer's Disease Research
Howard M. Kipen, M.D., M.P.H.
Professor of Environmental and Occupational Medicine and Director,
Clinical Research and Occupational Medicine Division
UMDNJ – Robert Wood Johnson Medical School
Kenneth W. Kizer, M.D., M.P.H.*
University of California Davis School of Medicine and Betty Irene Moore School of Nursing, and
Institute for Population Health Improvement
UC Davis Health System
Joel Kramer, Psy.D.
Professor of Neuropsychology, and
Director of the Memory and Aging Center Neuropsychology Program
School of Medicine
University of California
Francine Laden, M.S., Sc.D.
Professor of Environmental Epidemiology
Harvard T.H. Chan School of Public Health
James M. Noble, M.D.
Assistant Professor of Neurology
Neurological Institute of New York
Columbia University Medical Center
New York City
Anbesaw Selassie, Ph.D.
Department of Public Health Sciences
Medical University of South Carolina
Nancy F. Woods, Ph.D., R.N., FAAN*
Professor, Biobehavioral Nursing, and
School of Nursing
University of Washington
*Member, National Academy of Medicine