Veterans groups skeptical of earlier reports, citing biased VA contracting
Written by Anthony Hardie, Publisher/Editor
(91outcomes.com) This week, the Institute of Medicine (IOM), part of the National Academy of Sciences, will release the first of two parts of its eighth report in its “Gulf War and Health” series, Update of Health Effects of Serving in the Gulf War.
The IOM has conducted the series of studies -- mandated by the Persian Gulf War Veterans Act of 1998 and modeled after Agent Orange legislation -- to examine the scientific and medical literature on the potential health effects of veterans’ 1991 Gulf War exposures.
However, most of IOM’s previous Gulf War reports have come under fire from veterans groups and the powerful, congressionally-chartered Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC-GWVI), which have called the reports biased against veterans because they have led to very few presumptive conditions for veterans of the 1991 Gulf War.
Veterans groups and the RAC-GWVI have faulted U.S. Department of Veterans Affairs contracting authorities rather than IOM scientists, noting that IOM study committees have been contractually forced by VA authorities to specifically exclude considering critically important animal and other types of studies that are key to studying health outcomes of exposures to toxic substances present in the Gulf War.
The IOM reports are used by the VA to determine presumptive conditions for service-connected disability compensation and health care for the conditions.
Last month, VA Secretary Eric Shinseki used IOM study results to presumptively connect long-term health effects associated with nine rare infectious diseases endemic to the Persian Gulf region.
Shinseki also announced a rewrite of the rules related to Gulf War veterans’ illnesses to help with disability and health care claims by the 175,000 to 210,000 of the 697,000 veterans of the war believed to be affected by chronic multi-symptom illness.
IOM has conducted several previous public meetings related to the new report, as the committee has met to deliberate on published studies relevant to the issues at hand.
The IOM will host a public briefing on the new report on Friday, April 9, 2010, from 1:00 to 2:00 p.m. (Eastern Time). The briefing will be held in Room 700 in the National Academies Keck Center, 500 5th Street NW, Washington, DC. The building is located about one block from the Judiciary Square Metro station.
Information regarding the project can be found on the National Academies website at: http://www8.nationalacademies.org/cp/projectview.aspx?key=49036. If you are interested in attending, please email Joe Goodman (jgoodman@nas.edu) as space is limited. If you cannot attend in person and would like to listen to the briefing via telephone, please respond via email; a call-in number will be sent the week of the briefing to those who wish to listen.
According to Committee staff, this briefing is related to the release of the committee’s initial report (first phase of a two-phase study). A second report is scheduled to be completed and released in about 30 months, and will go more in-depth into the readjustment issues identified in the initial report.
Previous reports in the IOM Gulf War and Health series have included:
1. Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, and Vaccines, January 1, 2000.
This first study by IOM reviewed the scientific literature on depleted uranium, chemical warfare agents (sarin and cyclosarin), pyridostigmine bromide, and vaccines (anthrax and botulinum toxoid)
2. Gulf War and Health Volume 2. Insecticides and Solvents, Feb 18, 2003.
This report provides a comprehensive assessment of the available scientific literature on potential health effects of exposure to certain biological, chemical, and environmental agents associated with the Gulf War. In this second study, the committee evaluated the published, peer-reviewed literature on exposure to insecticides and solvents thought to have been present during the 1990-1991 war.
Because little information exists on actual exposure levels a critical factor when assessing health effects the committee could not draw specific conclusions about the health problems of Gulf War veterans. However, the study found some evidence, although usually limited, to link specific long-term health outcomes with exposure to certain insecticides and solvents.
3. Gulf War and Health: Volume 3. Fuels, Combustion Products, and Propellants. Released 2005.
This volume evaluates the long-term, human health effects associated with exposure to selected environmental agents, pollutants, and synthetic chemical compounds believed to have been present during the Gulf War. The committee specifically evaluated the literature on hydrogen sulfide, combustion products, hydrazine and red fuming nitric acid. Both the epidemiologic and toxicologic literature were reviewed.
4. Gulf War and Health: Volume 4. Health Effects of Serving in the Gulf War, Released: September 12, 2006.
This report differs from the previous work of IOM in that it summarizes in one place the current status of health effects in veterans deployed to the Persian Gulf irrespective of exposure information. The charge to this IOM committee was to review, evaluate, and summarize peer-reviewed scientific and medical literature addressing the health status of Gulf War veterans.
The committee found that although veterans of the first Gulf War report significantly more symptoms of illness than soldiers of the same period who were not deployed, studies have found no cluster of symptoms that constitute a syndrome unique to Gulf War veterans.
The committee did find evidence that suggests there may be an elevated rate of the rare disorder amyotrophic lateral sclerosis (ALS) among Gulf War veterans. However, there does not appear to be an increase in mortality and hospitalizations among Gulf War veterans. Evidence regarding rates of testicular cancer, brain cancer, and certain birth defects among Gulf War veterans is inconsistent and the committee recommended further surveillance for those health outcomes.
5. Gulf War and Health: Volume 5. Infectious Disease. Released: November 3, 2006.
This report reviewed long-term adverse human health effects associated with selected infectious diseases pertinent to Gulf War veterans. The infectious diseases include, but are not limited to, diseases caused by pathogenic Escherichia coli, shigellosis, leishmaniasis, and sandfly fever.
6. Gulf War and Health: Volume 6. Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress, Released: November 15, 2007.
This study comprehensively reviewed, evaluated, and summarized the peer-reviewed scientific and medical literature regarding the association between stress and long-term adverse health effects in Gulf War veterans, specifically the physiologic, psychologic, and psychosocial effects of stress.
The study was not limited to veterans of the 1991 Gulf War but also is applicable to veterans of Operation Iraqi Freedom and Operation Enduring Freedom.
7. Gulf War and Health: Volume 7. Long-term Consequences of Traumatic Brain Injury, Released: December 3, 2008.
This report assesses the possible long-term health outcomes of traumatic brain injury (TBI), detailing numerous outcomes that might be associated with mild, moderate, and severe injuries. These include: neurologic, endocrine, psychologic outcomes, in addition to problems with social functioning.
Recommendations are provided for study of blast injuries and the report suggests methods of data-gathering for future research to improve our understanding of blast injuries which ultimately would improve veteran care.
Additional IOM reports relevant to Gulf War veterans:
Gulf War Veterans: Treating Symptoms and Syndromes, Released: July 26, 2001
Potential health consequences of service in the Gulf War have been a concern since U.S. troops returned home. Research and investigations to date indicate there is no single illness or syndrome common to all ill veterans. Questions have arisen as to whether there are effective treatments for the problems ill veterans are experiencing, and whether these veterans are receiving appropriate care.
In response to Section 105 of this legislation, the Department of Veterans Affairs asked the Institute of Medicine to convene a committee that would:
- Identify and describe approaches for assessing treatment effectiveness;
- Identify illnesses and conditions among veterans of the Gulf War, using data obtained from the VA and the DoD Gulf War Registries, as well as information in published articles; and
- For these identified conditions and illnesses, identify validated models of treatment (to the extent that such treatments exist), or identify new approaches, theories, or research on management of patients with these conditions if validated treatments models are not available.
The congressional legislation specifically requested that the Academy study address undiagnosed illnesses as well as any other chronic illness deemed to warrant review.
Gulf War and Health: Updated Literature Review of Sarin Released: August 20, 2004
In a report released in 2000, the IOM revealed that exposure to the chemical warfare agent sarin can cause short-term symptoms such as severe cramping, difficulty breathing, twitching, pinpoint pupils and heavy sweating. However, there was not enough evidence to draw conclusions as to whether long-term health effects are associated with low-dose exposures.
In response to veterans' ongoing concerns and recent publications in the literature, IOM updated its 2000 report. In the report, Gulf War and Health: Updated Literature Review of Sarin, the committee concluded that there is still not enough evidence to determine whether exposure to low doses of sarin are associated with long-term health problems.
Gulf War and Health: Updated Literature Review of Depleted Uranium, Released: July 30, 2008.
In this most recent report, the committee concluded that there is still not enough evidence to determine whether exposure to depleted uranium is associated with long-term health problems.
Epidemiologic Studies of Veterans Exposed to Depleted Uranium: Feasibility and Design Issues, Released: July 30, 2008.
Depleted uranium, a component of some weapons systems, has been in use by the U.S. military since the 1991 Gulf War. Military personnel have been exposed to depleted uranium as the result of friendly fire incidents, cleanup and salvage operations, and proximity to burning depleted uranium-containing tanks and ammunition. Under a Congressional mandate, the Department of Defense sought guidance from the Institute of Medicine in evaluating the feasibility and design of an epidemiologic study that would assess health outcomes of exposure to depleted uranium.
The study committee examined several options to study health outcomes of depleted uranium exposure in military and veteran populations and concluded that it would be difficult to design a study to comprehensively assess depleted uranium-related health outcomes with currently available data. The committee further concluded that the option most likely to obtain useful information about depleted uranium-related health outcomes would be a prospective cohort study if future military operations involve exposure to depleted uranium.
The book contains recommendations aimed at improving future epidemiologic studies and identifying current active-duty military personnel and veterans with potential DU exposure.
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Background: The Persian Gulf War Veterans Act of 1998, Public Law 105-277, title XVI, 112 Stat. 2681-742 through 2681-749 (codified at 38 U.S.C. 1118), and the Veterans Programs Enhancement Act of 1998, Public Law 105-368,112 Stat. 3315, previously directed the Secretary to seek to enter into an agreement with the NAS IOM to review and evaluate the scientific literature regarding associations between illness and exposure to specific toxic agents, environmental or wartime hazards, or preventive medicines or vaccines to which service members may have been exposed during service in the Southwest Asia theater of operations during the Persian Gulf War.
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