This literature review, one of eight commissioned by the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses, summarizes the existing scientific literature on the health effects of pyridostigmine bromide that may have affected service members who served in Operations Desert Shield and Desert Storm. The eight RAND reviews are intended to complement efforts by the Defense Department and other federal agencies as they attempt to understand the full range of health implications of service in that conflict.

While many veterans have reported an array of physical and mental health complaints since the war, it is not yet clear the extent to which veterans are experiencing either higher-than-expected rates of identifiable illnesses with known etiologies or any other illnesses from as yet unidentified origins.

The other seven RAND literature reviews deal with chemical and biological warfare agents, depleted uranium, pesticides, oil well fires, immunizations, infectious diseases, and stress. The topics of these reviews all represent plausible causes of some of the illnesses Gulf War veterans have reported.

These reviews are intended principally to summarize the scientific literature on the known health effects of given exposures to these risk factors. Where available evidence permits, the reviews also summarize what is known about the range of actual exposures in the Gulf and assess the plausibility of the risk factor at hand as a cause of illnesses. Statements related to the Gulf War experience should be regarded as suggestive rather than definitive, for much more research both on health effects and exposures remains to be completed before more definitive statements are made. Recommendations for additional research where appropriate are also made.

These reviews are limited to literature published or accepted for publication in peer-reviewed journals, books, government publications, and conference proceedings. Unpublished information was occasionally used, but only to develop hypotheses.

This work is sponsored by the Office of the Special Assistant and was carried out jointly by RAND Health's Center for Military Health Policy Research and the Forces and Resources Policy Center of the National Defense Research Institute. The latter is a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the unified commands, and the defense agencies.