IOM Concurs Gulf War service linked to Multisymptom Illness in 250,000 Veterans

Second U.S. Government report to say Gulf War Syndrome is real

ORIGINAL 91OUTCOMES ARTICLE:  http://www.91outcomes.com/2010/04/iom-concurs-gulf-war-service-linked-to.html

(WASHINGTON – IOM RELEASE) -- Military service in the Persian Gulf War is a cause of post-traumatic stress disorder in some veterans and is also associated with multisymptom illness; gastrointestinal disorders such as irritable bowel syndrome; substance abuse, particularly alcoholism; and psychiatric problems such as anxiety disorder, says a new report from the Institute of Medicine, the latest update in a series of reports on the Gulf War and veterans' health. 

There is some evidence that service during the conflict is linked to fibromyalgia and chronic widespread pain, amyotrophic lateral sclerosis, sexual difficulties, and death due to causes such as car accidents in the early years after deployment, but the data are limited, said the committee that wrote the report.

There is a pressing need to answer lingering questions, such as why some veterans suffer a range of symptoms whereas others experience specific, isolated health problems or no ill health, and why some veterans who were not on the ground during the conflict or who arrived after combat ended have multisymptom illness, while others who served on the ground during the height of the battle have experienced few or no symptoms. 

The dearth of data on veterans' pre-deployment and immediate post-deployment health status and lack of measurement and monitoring of the various substances to which veterans may have been exposed make it difficult -- and in many cases impossible -- to reconstruct what happened to service members during their deployments nearly 20 years after the fact, the committee noted.

The report calls for a substantial commitment to improve identification and treatment of multisymptom illness in Gulf War veterans.  The path forward should include continued monitoring of Gulf War veterans and development of better medical care for those with persistent, unexplained symptoms.  Researchers should undertake studies comparing genetic variations and other differences in veterans experiencing multisymptom illness and asymptomatic veterans. 

It is likely that multisymptom illness results from the interactions between environmental exposures and genes, and genetics may predispose some individuals to illness, the committee noted.  There are sufficient numbers of veterans to conduct meaningful comparisons given that nearly 700,000 U.S. personnel were deployed to the region and more than 250,000 of them suffer from persistant, unexplained symptoms.  A consortium involving the U.S. Department of Veterans Affairs, U.S. Department of Defense, and National Institutes of Health could coordinate this effort and contribute the necessary resources.

The committee's review updates a 2006 IOM report that cataloged health effects occurring at higher rates among Gulf War veterans, and takes into account data and information generated since 2005.  This report takes a different approach to the issue of multisymptom illness than the 2006 study, which looked at analyses of unexplained illness and symptoms reported by veterans to determine whether they are experiencing a unique syndrome that could be defined by the symptoms.  The current study began with the premise that multisymptom illness is a diagnostic entity.  It examined the evidence to determine whether a link exists between multiple, unexplained symptoms and Gulf War deployment and, if so, how strong the association is.  The committee concluded that multisymptom illness is linked to Gulf War service, based on the availability of a number of good-quality surveys documenting increased reporting and occurrence of multiple, unexplained symptoms among veterans from several countries that sent troops, including the United Kingdom and Australia.

The data are not strong enough to draw conclusions about what chemical, drug, pollutant, or other substance could have caused these symptoms, the committee said.  Many questions remain about the underlying cause or causes of the complex of symptoms experienced by some veterans and about the adequacy of studies that have looked at the potential contributions of various substances to this disorder. 

"It is clear that a significant portion of the soldiers deployed to the Gulf War have experienced troubling constellations of symptoms that are difficult to categorize," said committee chair Stephen L. Hauser, professor and chair, department of neurology, University of California, San Francisco.  "Unfortunately, symptoms that cannot be easily quantified are sometimes incorrectly dismissed as insignificant and receive inadequate attention and funding by the medical and scientific establishment.  Veterans who continue to suffer from these symptoms deserve the very best that modern science and medicine can offer to speed the development of effective treatments, cures, and -- we hope -- prevention.  Our report suggests a path forward to accomplish this goal, and we believe that through a concerted national effort and rigorous scientific input, answers can be found."

The report was sponsored by the U.S. Department of Veterans Affairs.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  A committee roster follows.

Copies of Gulf War and Health, Vol. 8: Health Effects of Serving in the Gulf War Update 2009 are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu.  Reporters may obtain a copy from the Office of News and Public Information (contacts listed above). 

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Summary of Findings Regarding Associations Between Deployment to the Gulf War and Specific Health Outcomes

Sufficient Evidence of a Causal Relationship
• PTSD.

Sufficient Evidence of an Association
• Other psychiatric disorders, including generalized anxiety disorder and substance abuse, particularly alcohol
abuse. These psychiatric disorders persist for at least 10 years after deployment.
• Gastrointestinal symptoms consistent with functional gastrointestinal disorders such as irritable bowel syndrome
and functional dyspepsia.
• Multisymptom illness. (Affects 250,00, or 36% of veterans of hte 1991 Gulf War

Limited/Suggestive Evidence of an Association
• ALS.
• Fibromyalgia and chronic widespread pain.
• Self-reported sexual difficulties.
• Mortality from external causes, primarily motor-vehicle accidents, in the early years after deployment.

Inadequate/Insufficient Evidence to Determine Whether an Association Exists
• Any cancer.
• Diseases of the blood and blood-forming organs.
• Endocrine, nutritional, and metabolic diseases.
• Neurocognitive and neurobehavioral performance.
• Multiple sclerosis.
• Other neurologic outcomes.
• Incidence of cardiovascular diseases.
• Respiratory diseases.
• Structural gastrointestinal diseases.
• Skin diseases.
• Musculoskeletal system diseases.
• Specific conditions of the genitourinary system.
• Specific birth defects.
• Adverse pregnancy outcomes such as miscarriage, stillbirth, preterm birth, and low birth weight.
• Fertility problems.

Limited/Suggestive Evidence of No Association
• Peripheral neuropathy.
• Mortality from cardiovascular disease in the first 10 years after the war.
• Decreased lung function in the first 10 years after the war.
• Hospitalization for genitourinary diseases.