Gulf War Illness: A brief history

IOM, June 26, 2013
Roberta F. White, PhD Boston University School of Public Health RAC--Gulf War Illnesses

From Gulf War Syndrome to CMI to Gulf War Illness

• Early timeline
– 1991: Ft Devens Survey
• Focus: PTSD, psychiatric symptoms, health symptoms (HS36, short version)

– 1993: VA OPH clinical funding (Boston)
• Foci: PTSD, multiple chemical sensitivity, chronic fatigue syndrome, chemical exposures

– 1994-1999: VA Environmental Hazards Centers, Haley syndrome studies
• Three centers
– New Jersey (CFS/MCS) – Portland (case definition) – Boston (high symptom reporters, exposure-outcome)

• Early findings: Devens cohort
– PTSD, CFS, MCS rates too low to explain the excess health complaints seen (1-6%, depending on diagnosis) – Self-reported exposures related to increased symptom reporting and decreased scores on cognitive tests
• • • • SCUD missiles Nerve gas agents Pesticides Pyridostigmine bromide

• Studies over time: multiple researchers
– Regardless of case definition used, increased health symptom reporting was seen in deployed GW veterans relative to controls of all types – Case definitions varied widely, many were too broad – Exposure-outcome relationships were demonstrated for adverse health effects and levels of chemical exposures: pesticides, PB, sarin

• Studies over time
– Modeled levels of exposure to sarin, pesticides, PB and mixtures of pesticides/PB predicted lower scores on certain cognitive tests – Higher exposures also predicted lower brain matter volumes and disrupted white matter connectivity on brain MRIs – Levels of stress and PTSD diagnosis did not explain health symptoms or cognitive outcomes

• Studies over time
– “Chronic multi-symptom illness” from CDC/Fukuda emerged as one case definition of Gulf War Illness

• IOM 2010 report conclusions
– Epidemiologic studies comparing veterans who were deployed to the Gulf War with veterans who were in the military during the Gulf War have confirmed that deployed veterans have a greater prevalence of a number of medical conditions, illnesses and symptoms. This has also been seen in deployed veterans from many countries that formed the coalition forces (p.71). – (C)urrent estimates (are) that more than 250,000 US Gulf War veterans have persistent…medical symptoms (p.262)

• IOM 2010 report conclusions
– …the excess of unexplained medical symptoms reported by deployed Gulf War veterans cannot be reliably ascribed to any known psychiatric disorder (p. 109). – (T)here is sufficient evidence of an association between deployment to (the) Gulf War and chronic multi-symptom illness – The committee… accepted that multi-symptom illness was a diagnostic entity (p.204)

• IOM 2010 report conclusions
– It is likely that Gulf War illness results from an interplay of genetic and environmental factors (p. 261)

• VA physician treatment guidelines summary:
– What we do know is that chronic multisymptom illness is real and cannot be reliably ascribed to any known psychiatric disorder. Specifically, it cannot be ascribed to somatiform disorder, PTSD or depression. http://www.publichealth.va.gov/docs/vhi/caringfor-gulf-war-veterans-vhi.pdf

• Case definition implications of body of literature: Gulf War Illness
– Exposures
• Gulf theater exposure, 1990-1991

– Individual symptoms and symptom clusters – (Physiological indicators when available: brain, GI, immunological, genetic)

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