Some Key Quotes from IOM's "Gulf War and Health, Volume 10"

The following are some key quotes culled from the "Gulf War and Health: Volume 10" released today by the Institute of Medicine (IOM).  The IOM was contracted to do this report by the U.S. Department of Veterans Affairs (VA).

This is not an exhaustive list.  Readers should feel most welcome to post other key quotes in the comments section of this article.

-A.H.

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FAVORABLE TO GULF WAR VETERANS

“…the constellation of symptoms and symptom clusters referred to as Gulf War illness (e.g., fatigue, muscle and joint pain, and cognitive problems) is the signature adverse health outcome of having served in the Persian Gulf region.” (p.6)

“Multiple studies have 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.” (p.6)

“The increased prevalence of numerous symptoms has been seen in Gulf War veterans from the United States as well as several of the coalition countries (e.g., Australia, United Kingdom, and Denmark).” (p.6)

“Recommendation: The Department of Veterans Affairs should continue to conduct follow-up assessments of Gulf War veterans for neurodegenerative diseases that have long latencies and are associated with aging; these include amyotrophic lateral sclerosis, Alzheimer’s disease, and Parkinson’s disease.” (p.8)

“Recommendation: The Department of Veterans Affairs should conduct further assessments of cancer incidence, prevalence, and mortality because of the long latency of some cancers. Such studies should maximize the use of cancer registries and other relevant sources, data, and approaches, and should have sufficient sample sizeds to account for relatively rare cancers. These studies should also be able to report sex-specific and race/ethnicity-specific information.” (p.9)

“For future conflicts …, collecting exposure information before, during, and after deployment, preferably using individual environmental monitoring devices and military health and administrative records to capture such information as vaccine administration, troop location, and toxicant concentrations, will permit a more accurate assessment of actual exposures.” (p.10)

“Recommendation: Sex-specific and race/ethnicity-specific health conditions should be determined and reported in future studies of Gulf War veterans.  In addition, selected prior studies (e.g., large cohort studies) should be reviewed to determine whether reanalysis of the data to assess for possible sex-specific and race/ethnic-specific health conditions is feasible.”  (p.10)

“Recommendation: Future Gulf War research should place top priority on the identification and development of effective therapeutic interventions and management strategies for Gulf War illness.  The Department of Veterans Affairs should support research to determine how such treatments can be widely disseminated and implemented in all health care settings.” (p.11)

“Gulf War illness continues to be the signature health concern of veterans who served in the Persian Gulf region in 1990-91.” (p.87)

“A variety of studies in U.S. veterans and coalition force veterans who served during and even after the conflict continue to show that veterans who were deployed to the Gulf War experience more symptoms, signs, and ill-defined conditions, and that their symptoms are more severe than their nondeployed counterparts; furthermore, these symptoms have persisted for more than 25 years after the war.” (p.87)

“Therefore, the Volume 10 committee concludes that there is sufficient evidence of an association between deployment to the Gulf War and the constellation of chronic symptoms (including fatigue, musculoskeletal pain, sleep disturbance, cognitive dysfunction, alterations of mood) known as Gulf War illness.” (p.88)

“Because cancer incidence in the last 10 years has not been reported, additional follow-up is needed.” (p.102).

MIXED FAVORABILITY TO GULF WAR VETERANS

“The committee finds that the association of deployment to the Gulf War with PTSD, anxiety disorders, substance abuse, and depression is well established, and further studies to assess whether there is an association are not warranted.” (p.9)

“Further exploration of treatments and management strategies for the symptoms of Gulf War illness, even in the absence of a definitive etiology, is warranted.” (p.11)

“Gulf War illness research should be realigned to focus on the treatment of the illness’s complex symptomatology rather than its causal mechanisms.”  (p.11)

“Together, these studies suggest the possibility that chemical exposures – PB, pesticides, insecticide treatment, and alarms – may play a role in Gulf War illness.  Nevertheless, the committee cautions that a substantial limitation to this potential association is the lack of any measure that clearly documents the actual chemicals or doses to which veterans were exposed.” …. “The committee concludes that, on the basis of the studies of deployment exposures and Gulf War illness (e.g., Steele et al., 2015; Haley and Tuite, 2013; Iannacchione et al., 2011), there is little new information that sheds light on the etiology of or mechanisms for Gulf War illness.”  (p. 81)

“There are no reliable or validated biomarkers to indicate that a particular veteran with or without Gulf War illness had a specific chemical exposure during deployment.” (p.81)

“…there is little biologic plausibility for the concept that exposure to PB concentrations that did not cause acute effects would result in long-term effects (IOM, 2004).” (p.81) 

“For the most part, the studies reviewed by Gulf War and Health committees, including this committee, have not adequately determined the cause of PTSD in any of the veterans.” (p.133)

NOT FAVORABLE TO GULF WAR VETERANS

“…[the committee] cautions that developing such an animal model is not possible given researchers’ inability to realistically determine the exposures associated with Gulf War service, let alone the frequeny, duration, or dose of those exposures, or the effect of multiple exposures.”  (p.5)

…the committee focused on the epidemiologic literature in making its findings…” (p.6)

“Gulf War illness is not an easily diagnosed condition.” (p.6)

“Based on the 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.” (pp. 6-8)

“A further problem is that most of the studies have excluded the psychological aspects of Gulf War illness with regard to both diagnosis and treatment.”  (p.8)

“Animal studies that attempt to mirror Gulf War illness have been of little use because it is difficult to establish experimental exposures that are representative of those experienced by Gulf War veterans during deployment.” (p.8)

“Recommendation: Any future studies of Gulf War illness should recognize the connections and complex relationships between brain and physical functioning and should not exclude any aspect of the illness with regard to improving its diagnosis and treatment.”  (p.8)

“The new studies identified by the committee found no statistically significant increase in the risk of brain cancer in deployed Gulf War veterans compared with their nondeployed counterparts. The studies indicate that the evidence for an association between deployment to the Gulf War and brain cancer is inadequate/insufficient.” (p.9)

“In contrast to cancer, the committee finds that sufficient time has elapsed to determine that Gulf War deployed veterans do not have an increased incidence of circulatory, hematologic, respiratory, musculoskeletal, gastrointestinal, genitourinary, reproductive, and chronic conditions compared with their nondeployed counterparts.” (p.9)

“Recommendation: Further studies to assess the increased incidence and prevalence of circulatory, hematologic, musculoskeletal, gastrointestinal, genitourinary, reproductive, endocrine and metabolic, respiratory, chronic skin, and mental health conditions due to deployment in the Gulf War should not be undertaken.  Rather, future research related to these conditions should focus on ensuring that Gulf War veterans with them receive timely and effective treatment.”  (pp.9-10)

“…efforts to model or otherwise reconstruct the exposures that Gulf War veterans experienced during deployment are also unlikely to yield useful results.” (p.10)

“…the applicability of those laboratory exposures to the real-world exposures of veterans will continue to be unknown.”  (p.10)

“Little credible information currently exists for U.S. Gulf War veterans (except for depleted uranium).” (p.10)

“Recommendation: Without definitive and verifiable individual veteran exposure information, further studies to determine cause-and-effect relationships between Gulf War exposures and health conditions in Gulf War veterans should not be undertaken.” (p.10)

“… the health conditions found to be associated with Gulf War deployment are primarily mental health disorders and functional medical disorders. What links these conditions is that they have no objective medical diagnostic tests and are diagnosed based on subjective symptom reporting.  These associations emphasize the interconnectedness of the brain and body.  The committee concludes that it is time research efforts move forward and focus on this interconnectedness when seeking to improve treatment of veterans for Gulf War illness.” (p.11)

“Such research should recognized the growing evidentiary base demonstrating the intricate and complex brain-body relationship.” (p.11)

“In spite of concerted efforts to identify a cause or physiologic mechanism for Gulf War illness, no clear answer has been established.” (p.87)

“Several new studies report associations between several exposures, particularly to chemicals, and the presence of Gulf War illness, but to date, there are no reliable or validated biomarkers of exposure or symptoms to substantiate the etiology or mechanisms of the illness.” (p.87)

“…one of the difficulties in studying Gulf War illness is the several case definitions and the variable presentations of this condition.” (p.88)

“there is insufficient/inadequate evidence to determine whether an association exists between deployment to the Gulf War and the incidence or prevalence of any cancer.”  (p.101)

“No statistically significant differences for brain cancer were identified in either of the primary studies.  Volumes 4 and 8 described studies … that reported an increased risk of brain cancer mortality potentially associated with demolition of chemical munitions at Khamisiyah, however these authors based exposure on a plume model for which there is considerable uncertainty (GAO, 2004). The committee thus concurs with the Volume 4 and 8 committees that there is insufficient/inadequate evidence of an association between demolitions at Khamisiyah and an increased risk of brain cancer.” (pp.101-02)

“…the Volume 10 committee concludes that there is insufficient/inadequate evidence to determine whether an association exists between deployment to the Gulf War and any form of cancer, including lung cancer and brain cancer.” (p.102)

“One large study that assessed Gulf War veterans over time, found that between 1995 and 2005, the number of deployed veterans with PTSD increased significantly (p < 0.05) from 12.01% to 14.4%, and this rate was three times that of nondeployed veterans (3.9% and 4.0%, respectively).” (p.132)

“Other studies have found that the presence of PTSD increases the risk of having other psychiatric and physical conditions (IOM, 2012)” (p.132)

“…animal studies have typically examined isolated symptoms of Gulf War illness rather than the symptom clusters reported by veterans.” (p.251)

“Animal studies have not been successful in suggesting a mechanism by which deployment exposures during the Gulf War might lead to Gulf War illness or its many symptoms.” (p.251)

“The committee concludes that although the existence of an animal model would be advantageous for identifying and evaluating treatment strategies for Gulf War illness, it cautions that developing such an animal model is not possible given researchers’ inability to realistically determine the exposures associated with Gulf War deployment, let alone the frequency, duration, or dose of those exposures, or the effect of multiple exposures.” (p.251)

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