Background Document on Gulf War-Related Research for The

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Health Impact of Chemical Exposures During the Gulf War: A

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Research Planning Conference February 28 - March 2, 1999

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Agency for Toxic Substances and Disease Registry

1999

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Table of Contents

EXECUTIVE SUMMARY 1

1. Purpose of the Conference 5

2. The Gulf War: Overview . 5

3. Illnesses Among Gulf War Veterans . 6

The Department of Veterans’ Affairs Persian Gulf Health Registry and the Department of Defense

Comprehensive Clinical Evaluation Program . 6

Conclusions and Research Recommendations from Review Panels . 11

4. Overview: U.S. Government-Supported Research on Gulf War Illnesses . 12

5. Gulf War Illnesses: Research Results . 14

Mortality and Hospitalization Studies 14

Studies of Self-reported Symptoms in Gulf War-Deployed and Non-deployed Veterans . 15

Neurophysiological and Neuropsychological Evaluations of Symptomatic Gulf War Veterans 19

Studies of Neurological Effects from Mixtures of Chemicals and other Risk Factors . 23

Genetic Differences in Susceptibility to Environmental Agents . 26

Multiple Chemical Sensitivity in Gulf War Veterans . 27

Treatment of Gulf War Veterans with Non-specific Chronic Symptoms of Ill Health 30

6. Concluding Remarks 32

7. References . 34

APPENDICES 43

Appendix A: Account of Events Related to Health Concerns of Gulf War Veterans 43

Reporting of Gulf War Illnesses and U.S. Governmental Response 43

Review Panels and Groups 44

References 51

Appendix B: Exposure to Chemicals During the Gulf War . 53

Chemical Warfare Agents . 53

Pyridostigmine Bromide . 55

Biological Warfare Agents 57

Infectious Diseases 58

Immunizations . 59

Depleted Uranium (DU) 60

Pesticides . 61

Smoke from Oil Well Fires 62

Petroleum Products and Other Chemicals . 63

The Desert Environment . 64

Psychological and Physical Stressors 64

General Exposures of Military Service . 65

References 66

Appendix C: Research on Gulf War Illnesses: Description and Evaluation of Selected Studies 72

Mortality and Hospitalization Studies . 72

Mortality and Hospitalization Studies Summary 77

Critique of Mortality and Hospitalization Studies . 78

Studies of Self-Reported Symptoms in Gulf War Deployed and Non-Deployed Veterans 78

Neurophysiological and Neuropsychological Evaluations of Symptomatic Gulf War Veterans 83

Mycoplasma and Bacterial Infections in Gulf War Veterans with Illnesses: Detection and Treatment

. 87

Appendix D. Ongoing Research Related to Illnesses Among Gulf War Veterans . 90

A. Multiple Chemical Sensitivity in Gulf War Veterans 90

B. Genetic Differences in Susceptibility / Biomarkers of Disease . 91

C. Toxicity of Mixtures of Chemicals and Other Risk Factors . 92

D. Treatment of Gulf War Veterans with Illnesses 94

E. Toxicity of Low-Level Exposure to Chemical Warfare Agents 94

F. Toxicity of Pyridostigmine Bromide. 95

G. Assessment/Definition of Gulf War Illnesses 96

H. Disease Prevalence and Associations Between Chemical Exposure and Illnesses in Gulf War

Veterans . 100

I. Toxicology of Depleted Uranium 102