Presidential Advisory Committee on Gulf War Veterans' Illnesses
President Clinton established the Presidential Advisory Committee on Gulf War Veterans' Illnesses in May 1995 to ensure an independent, open, and comprehensive examination of health concerns related to Gulf War service. The Committee, a 12-member panel made up of veterans, scientists, health care professionals, and policy experts, held 18 public meetings between August 1995 and November 1996. We heard invited testimony and received public comment at each meeting. Staff held in-house consultations, received briefings, conducted literature reviews, interviewed veterans, and reviewed government documents throughout our tenure. We analyzed information on the full range of activities specified in our charter-research, coordinating efforts, medical treatment, outreach, reviews conducted by other governmental and nongovernmental bodies, risk factors (exposure and health effects), and chemical and biological weapons-to reach our findings and recommendations. The Final Report presents the Committee's conclusions in three major parts:
Findings and recommendations specific to the needs of Gulf War veterans appear throughout the Final Report and are summarized here.
The Committee's primary focus was on Gulf War veterans' illnesses, but parallels with the health concerns of Vietnam veterans became increasingly obvious over time. Thus, the Committee also decided to include in its analysis, recommendations on how to anticipate and avoid post-conflict health concerns.
ADDRESSING GULF WAR VETERANS' ILLNESSES
Overall, the Committee is encouraged by the government's response to the range of health-related problems experienced by Gulf War veterans. We found the Vet Centers and Persian Gulf Family Support Program established by the Department of Veterans Affairs (VA) to be effective outreach programs and recommend that these field-based initiatives serve as models for health education and risk communication campaigns.
The Committee agrees with the Institute of Medicine's conclusion that the clinical evaluation programs of the Department of Defense (DOD) and VA are excellent for the diagnosis of Gulf War veterans' illnesses. We found some shortcomings in the availability of treatment, particularly with regard to mental health and reproductive health, and recommend better follow-up care in these areas.
The Committee found that the government's research portfolio is appropriately weighted toward epidemiologic studies and studies on stress-related disorders that are likely to improve our understanding of Gulf War veterans' illnesses. To close gaps in the current knowledge base, we recommend additional research on the long-term health effects of low-level exposures to chemical warfare agents and on the synergistic effects of pyridostigmine bromide-a chemical warfare agent pretreatment- with other Gulf War risk factors. We also recommend more emphasis on basic and applied research on the body's physical response to stress.
The existing knowledge base, including results from epidemiologic studies of Gulf War veterans, data from clinical evaluation and treatment programs for Gulf War veterans, and published literature from decades of toxicologic research, enabled the Committee to reach some conclusions about the nature and causes of Gulf War veterans' illnesses. We found that:
Currently, the extent of service-connected illness among Gulf War veterans is unknown, but the Committee anticipates results from the large, population-based epidemiologic studies now underway will shed light on this issue. In addition to the government's existing research, the Committee also recommends that mortality studies of Gulf War veterans continue, since some health effects, such as cancer, would not be expected to appear until a decade or more after the end of the Gulf War.
Although somewhat slow to act at the end of the Gulf War, the government is now providing appropriate medical care to Gulf War veterans and has initiated research in the areas most likely to illuminate the causes of their illnesses. The Committee identified ways to fine-tune those efforts, but found that, for the most part, the government has acted in good faith to address veterans' health concerns.
The Committee takes issue with the government's performance in one key area: investigation of possible exposures of U.S. troops to chemical
and biological warfare agents in the Gulf. We found substantial evidence of site-specific, low-level exposures to chemical warfare agents. Moreover, we found DOD's investigations to date superficial and unlikely to provide credible answers to veterans' and the public's questions. DOD's failure to seriously investigate chemical warfare agent exposures also adversely affected decisions related to funding research into possible health effects of low-level exposures to chemical warfare agents. At the Committee's final meeting in November 1996, DOD announced plans to revamp its investigatory and research programs related to low-level chemical warfare agent exposure. The Committee believes these efforts-combined with independent, high-quality oversight-could begin to restore public confidence in the government's investigations of possible incidents of chemical warfare agent exposure. Given that these steps come too late for the Committee to evaluate, however, we emphasize the importance of the following recommendation:
The government has a significant amount of ground to recover with Gulf War veterans and the American public, who have come to question whether a lack of data-on possible chemical warfare agent exposures, on the pre- or post-deployment health of veterans, or on the location of troops in-theater-indicates a lack of commitment to veterans' health. We recognize the many laudatory actions taken to address the concerns of Gulf War veterans, but the Committee believes the government can do a better job of anticipating and avoiding these types of problems. We offer the following findings and recommendations in that spirit.
AVOIDING POST-CONFLICT HEALTH CONCERNS
The Committee was impressed by the professionalism of the individuals responsible for the government services we evaluated. We believe the expertise needed to improve technical performance and implement policy and procedural changes resides within the government, but we also believe that DOD and VA have much to learn from their peers in other agencies. Therefore, the Committee recommends that:
The NSTC's agenda should include the following recommendations for better communication, data, and services, which were developed during the Committee's evaluation of issues related to Gulf War veterans' illnesses (see Final Report, chapter 2 and chapter 4).
Clearly, the volunteers who serve in defense of our Nation deserve complete and accurate information about the risks they face. An open democracy demands that the public, as well, has the opportunity to engage in policy debates that accompany the commitment of troops abroad. Therefore, the Committee recommends that:
Many of the health concerns of Gulf War veterans may never be resolved fully because of the lack of data. The Committee identified problems related to missing medical records, the absence of baseline health data, inaccurate records of troop locations, and incomplete data on the health effects of what should have been viewed as reasonably anticipated risks. To help prevent similar problems in the future, we recommend that:
The Nation has long provided care to veterans for service-connected health problems. Unfortunately, the government continues to give short shrift to veterans' legitimate concerns about reproductive health, and society at large continues to stigmatize mental health concerns. Therefore, the Committee recommends that:
the government conduct a thorough review of VA's policies concerning reproductive health and seek statutory authority to treat veterans and their families for service-connected problems. When indicated, genetic counseling should be provided-either via VA treatment facilities or referral-to assist veterans and their families who have reproductive concerns stemming from military service.
the government continue and intensify efforts to develop stress reduction programs for all troops, with special emphasis on deployed troops.
Approximately 697,000 men and women answered the call to serve in Operations Desert Shield/Desert Storm. In many important ways-through medical care, outreach, and research-the Nation has begun to pay its debt to these service members. It is essential, now, to move swiftly toward resolving Gulf War veterans' principal remaining concerns: How many U.S. troops were exposed to chemical warfare agents, and to what degree?
A continued and sustained commitment to a healthy future for Gulf War veterans-for all current and future veterans-is a priority for all Americans. This Final Report represents the Committee's contribution to that goal. We have given our full dedication to President Clinton's charge and have appreciated the opportunity to serve Gulf War veterans and their families.
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