A.6 SUMMARY OF HEALTH RISK ASSESSMENT
A. Introduction and Major Findings
As part of this investigation, OSA performed a health risk assessment (HRA) of pesticide use by land-based servicemembers deployed to the Gulf. This HRA only addresses those exposed to pesticides, not the entire US military population in the Gulf. The HRA is a highly technical report, and is presented in its entirety as Part B of this report. What follows is a summary of Part B.
The purpose of the HRA is to provide an estimate of the likelihood of certain specific effects from pesticide exposures during the Gulf War. Such effects would have been limited to the time of deployment, and may or may not have implications for long-term health effects. Exposure means pesticide contact mainly with skin, stomach, or lungs. In general, most exposures to pesticides are harmless; however, overexposure or exposure to too much of a pesticide may cause illness.
We did not locate any records generated during the Gulf War that told us specifically which pesticides were used, how they were used, or how much was used. We did have information on which pesticides were in US military stocks at the time, and which pesticides some deploying units ordered (see Tab C-7). We also reviewed the military guidance on how pesticides should have been used by troops. The thousands of veterans we talked to from 1997 through 1999 told us what they remembered about pesticide use during the deployment, six to nine years prior. Based on this information, we made a number of assumptions about pesticide usage in order to estimate, as best as possible, the levels of exposure.
1. What the HRA Tells Us
The HRA is useful in identifying groups who because of their occupational specialty may have been at greater risk for adverse health effects arising from exposures to pesticides. If the assumptions of the HRA are accurate, some US personnel may have been exposed to levels of pesticides that would be considered unhealthful when evaluated by current risk assessment methods. Some levels judged unhealthful today would have been considered acceptable by competent authorities in 1990-1991. Many more veterans were also exposed to pesticides, but at levels insufficient to cause even minor health problems. In other words, the majority of veterans were almost certainly not exposed to unhealthful levels of pesticides. A few veterans did tell us that they recalled experiencing or witnessing symptoms of pesticide overexposure.
2. What the HRA Does Not Tell Us
The HRA alone does not prove either that pesticide overexposures occurred during the Gulf War, or that any connection exists between pesticide exposures and chronic health effects months or years after exposure. Conversely, the HRA does not discount a possible role for pesticides in causing or contributing to some of the as-yet undiagnosed illnesses reported by some veterans.
There is scientific evidence from other published sources that repeated and prolonged exposure to organophosphate pesticides or similar chemicals, at levels high enough to cause severe signs and symptoms at the time of exposure, may lead to neurological problems lasting months or years beyond exposure. The HRA does not provide evidence that such problems occurred, and our best information is that fewer than 10 veterans sought medical treatment for pesticide exposures.
It is possible that some of those exposed to the highest levels of organophosphate and carbamate pesticides may have experienced subtle effects to the nervous system during deployment. The HRA does not provide evidence that such effects occurred. In nearly all cases, the affected veteran would have been unaware of any effects, and would probably have experienced no lingering health effects. In a few cases, the affected veteran may have experienced at least some mild symptoms of overexposure such as a temporary cough, burning eyes, and runny nose. Even in these cases, we expect most or all of those exposed would have quickly recovered, without lingering health problems.
The HRA does not fully address certain combined exposures that may be of importance, such as pesticides in combination with other pesticides and pesticides in combination with pyridostigmine bromide (PB). It also does not account for how DEET may influence absorption of other pesticides and PB, possibly increasing toxicity.
B. Data Collection
Since we could find no specific documentation on pesticide use during the Gulf War, the HRA is based on a scientific survey of 2,005 randomly selected Gulf War veterans, interviews of 252 preventive medicine personnel and other individuals involved in pesticide activities, military supply records, military pesticide guidance, and available operational data. The investigation into the delousing operations, which involved the use of lindane, generated 35 additional interviews with military police and medical personnel.
Data collection identified 37 active ingredients probably used in the Gulf. Investigators selected for detailed analysis 15 pesticide products, containing 12 different active ingredients. Investigators made their selections based on the number of reports for each, the toxicity of each, and the potential each pesticide had to expose personnel.
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