From the Institute of Medicine, late last month:
About one-third of veterans – an estimated 175,000 to 250,000 military personnel – of the 1991 Gulf War suffer from an array of long-term medically unexplained symptoms known as chronic multisymptom illness (CMI), a serious health condition that imposes a tremendous burden of suffering. CMI does not have a defined set of symptoms and can vary from person to person. Veterans with CMI may experience physical symptoms, such as fatigue and joint and muscle pain; cognitive symptoms, such as memory difficulties; and symptoms often associated with depression and anxiety.
Since 1998, the IOM has issued a series of congressionally mandated reports on behalf of the Department of Veterans Affairs (VA) that have examined the scientific and medical literature on the potential health effects of chemical and biological agents related to the Gulf War. Unlike previous work, this report comprehensively reviews and evaluates treatments for CMI to determine how to best manage care for veterans. This report says that, in changing how it treats CMI, the VA can make a significant difference in the lives of veterans who have the condition by helping to ensure they receive more integrated, comprehensive and responsive health care.
And the takeaway?
There is no single therapy or universal treatment approach that will help all veterans experiencing chronic multisymptom illness (CMI), says a new report from the Institute of Medicine. The U.S. Department of Veterans Affairs should customize care with an array of therapies tailored to each former service member’s needs, said the committee that wrote the report.
That stands in stark contrast to some of the conclusions of the VA Research Advisory Committee on Gulf War Veterans Illnesses in 2008:
The only study of Gulf War veterans who were in the immediate vicinity of the Khamisiyah demolitionsfound that some did have symptoms of nerve agent exposure at the time. Investigators from VA’s Portland Environmental Hazards Research Center surveyed nearly 3,000 Gulf War veterans who had beenin different areas during the first two weeks after the cease fire, when the major Khamisiyah demolitionshad taken place. Veterans were asked about symptoms they experienced during that period, as well assymptoms they had at the time of the survey, nine years after the war. Overall, symptoms reported by veterans who were within a 50 km. radius of Khamisiyah during early March of 1991 were similar tothose of veterans in other areas of theater. However, veterans who had directly participated in theKhamisiyah demolitions, or had witnessed the demolitions, reported significantly higher rates of anumber of symptoms during that period, primarily symptoms suggestive of nerve agent exposure—headaches, nausea, vision problems, cramping, runny nose, and muscle twitching. Results suggest thatsome veterans in close proximity to the Khamisiyah demolitions may have had cholinergic symptoms at the time of exposure.
Some of their findings:
Department of Veterans Affairs investigators in Washington, D.C. used the 2000 Khamisiyah models to assess mortality rates in Gulf War veterans relative to nerve agent exposure. In 2005, they reported that modeled exposure to nerve agents was associated with a significantly increased rate of death due to brain cancer. The rate of brain cancer mortality among veterans downwind from the Khamisiyah demolitions was about twice as high, overall, as the rate in veterans who had been located elsewhere. This reflected 25 brain cancer deaths prior to the year 2001 among the 100,487 Gulf War veterans identified as potentially exposed to nerve agents. A dose response effect was also identified, indicating that exposure for two or more days was associated with a greater than three-fold increased risk of death due to brain cancer.
Studies have also reported measurable difference in neurobehavioral performance and brain structure in relation to low-level nerve agent exposures following the Khamisiyah demolitions. Investigators from VA’s Boston Environmental Hazards Center assessed neurocognitive performance in veterans in the Fort Devens cohort between 1994 and 1996, and initially found that veterans who reported being exposed to chemical or biological warfare agents had significant decrements on a number of specific cognitive tasks.
Years later, testing results were reevaluated to assess measured outcomes in relation to DOD-modeled exposures to sarin and cyclosarin following demolitions at Khamisiyah. Since testing had occurred before the Khamisiyah exposures had been made public, the available data allowed assessment of cognitive performance that was effectively blinded to exposure status. In tests conducted four to five years after exposure, modeled levels of nerve agent exposure were significantly associated with reduced performance on neurobehavioral tasks related to visuospatial and psychomotor abilities, in a dose response manner.
Did anyone on this IOM panel even bother to consult the authors of the RACGWVI report?