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RAND Releases Studies in Gulf War Illness Series
RAND has been commissioned by the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses to help the Defense Department and other federal agencies understand the health implications of service during the war. RAND has released several scientific literature reviews as a result of this effort. These reviews examine the potential effects of Pyridostigmine Bromide (PB), oil well fires, and depleted uranium (DU) on Gulf War Veterans.
Publication Abstracts
Volume 1: A Review of the Scientific Literature As It Pertains to Gulf War Illnesses;Infectious Diseases — 2000
Numerous Gulf War veterans have reported a range of illnesses and symptoms after serving in the Persian Gulf. Some of the reported symptoms are similar to those caused by diseases known to be prevalent in that region. This report discusses these infectious diseases and considers them as potential causes of the symptoms reported by the veterans. The authors present a short summary of etiology, diagnosis, and treatment for several infectious diseases and infectious organisms, including bacterial, viral, and parasitic infections. Two biological agents - anthrax and botulinum toxin - are also discussed.
Volume 2: A Review of the Scientific Literature As It Pertains to Gulf War Illnesses; Pyridostigmine Bromide — 1999
The United States and its allies in the Persian Gulf War (PGW) knew that Iraq had used nerve agents and chemical weapons in its previous conflicts and so took steps to protect their troops. Pyridostigmine bromide (PB) was distributed as a pretreatment that would enhance the effectiveness of postexposure treatments in the event that the nerve agent soman was used. This report examines the role that PB played in the ongoing chronic health problems documented in PGW veterans. After careful examination of the known effects of PB on the central and peripheral nervous systems, the author finds enough evidence consistent with a possible role for PB as a contributor to the undiagnosed health of some PGW veterans that she cannot reject PB as a possible contributing factor. The paper calls for immediate attention in the form of additional investigation to clarify the role of PB.
Volume 4: Stress — 2000
A significant proportion of US military personnel who served in the Persian Gulf War have reported various health problems following their service, some of which remain unexplained. The conflict presented these veterans with an array of stressful experiences both before, during, and after deployment, and those experiences may have contributed to their reported health difficulties. Research recorded in the general scientific literature has shown that stress can produce myriad health effects, and these effects can manifest themselves as symptoms and conditions similar to those that the veterans report. Empirical studies of Gulf War veterans indicate that stress plays some role in the etiology or exacerbation, yet available research does not demonstrate the causal role of stress in the unexplained illnesses in Gulf War veterans.
Volume 5: Chemical and Biological Warfare Agents — 2000
That Iraq had already used chemical warfare agents lead coalition forces to take protective action. Yet many Gulf War veterans have reported a host of symptoms that could be construed as coming from exposure to chemical or biological weapons. The scientific literature on the effects of exposure to such agents suggests the following: Militarily effective doses of any of the agents reviewed would have produced severe health effects that would have required clinical treatment or resulted in death. However, since low-level exposures could have produced mild clinical signs that could have been overlooked or misinterpreted, it is not possible to rule out low-dose exposures to one or several classes of agents or the possibility of some resultant contribution to some of the symptoms Gulf War veterans have experienced. Still, it is difficult to believe that exposures affecting large numbers of persons would escape clinical recognition. Further, no references in the literature report clinical symptoms developing years after exposure, as was the case in about 50 percent of the health problems Gulf War veterans have reported.
Volume 6: Oil Well Fires — 1998
When the Iraqi army withdrew from Kuwait during the Gulf War, it left the Kuwait oil fields in flames. Burning crude oil produces a wide range of pollutants. This report examines the peer-reviewed scientific literature regarding possible health effects on US troops of exposure to the oil well fires. The author reports that measurements taken in Kuwait and Saudi Arabia, where most troops were assigned, showed concentrations of pollutants to be orders of magnitude lower than recommended occupational standards in the United States and comparable to ambient levels. The literature review revealed no health effects associated with the pollutants at the levels measured during the oil fires. Particulate matter concentrations were high, but were largely attributable to sand granules of a size that can affect the respiratory systems of sensitive populations subgroups such as smokers or asthmatics.
Volume 7: Depleted Uranium — 1999
Because of the metal's density and metallurgical properties, depleted uranium (DU) saw widespread use during the Persian Gulf War in improved armor and antiarmor rounds of increased penetrating power. This report examines the scientific literature regarding possible health effects on US troops of exposure to DU. While very little literature directly addresses DU, a wide body of literature deals with the health effects of natural uranium and enriched uranium. DU is toxicologically identical to natural uranium and radiologically more benign because it is less radioactive. No increase in overall deaths has been observed as a result of exposure to natural uranium in several epidemiological studies. The literature review paid close attention to the ongoing study of a group of Gulf War veterans who received the highest exposure to DU. Those with embedded fragments have elevated urine uranium levels, but researchers report neither adverse renal effects attributable to DU nor any adverse health effects related to DU radiation.
Military Use of Drugs Not Yet Approved by the FDA for CW/BW Defense: Lessons from the Gulf War — 1999
The confrontation that began when Iraq invaded Kuwait in August 1990 brought with it the threat that chemical and biological weapons might be used against the more than half a million military personnel the United States deployed to the region. To protect these troops from such threats, the Department of Defense wished to use drugs and vaccines that, not having been tested for use in these specific situations, were considered "investigational" by the federal Food and Drug Administration. This report examines the history of the Interim Rule, adopted in December 21, 1990, that authorized the Commissioner of Food and Drugs to waive informed consent for the use of investigational drugs and vaccines for certain military uses; how this authority was used for pyridostigmine bromide and botulinum toxoid during the Gulf War; and the subsequent controversy surrounding the rule, its application, and its implications. The report then analyzes the issues the Interim Rule raised when investigational drugs are used for such purposes and makes recommendations for dealing with similar situations in the future.
Volume 8: Pesticides — 2001
This report summarizes the scientific literature on 12 of the 35 pesticides that are likely to have been used during the Persian Gulf War. Where possible, it focuses on known pesticide exposures or doses and related health outcomes that may be relevant to symptoms reported by some Gulf War veterans. Particular attention is paid to long-term, chronic effects of reported exposures to organophosphate and carbamate pesticides. Evidence from epidemiological studies, studies of genetic and biological differences between ill and healthy subjects, and studies of the physiological mechanisms of organophosphate and carbamate pesticides is suggestive, but not conclusive, that these pesticides could be among the potential contributing agents to some of the undiagnosed illnesses seen in Gulf War veterans. However, no prospective studies have been conducted that positively identify pesticides as causative agents. More research is needed to confirm or refute a causal link between pesticides and other agents and the symptoms associated with Gulf War illnesses.
Pesticide Use During the Gulf War: A Survey of Gulf War Veterans — 2000
This report summarizes the results of a RAND survey designed to quantify the use of pesticides by the average U.S. military service member during Operation Desert Shield/Desert Storm between August 1990 and July 1991. The survey was administered by telephone to 2,005 Gulf War veterans who served on the ground in the Kuwaiti theater of operations. Survey results characterize U.S. service members' personal and field use of pesticides, as well as observed pesticide use by others. Information was obtained for pesticides used in living, working, and eating areas for a randomly chosen month of deployment. Results show that the majority of personnel were exposed to some pesticides. Results also show there were differences in pesticide use by branch of service, small differences by season and by rank, and larger differences by living arrangements. Although the authors found no evidence of widespread misuse of pesticides, some cases of possible misuse were identified. However, with the exception of animal flea collars worn by service members, these cases could just as well be attributed to mis-identification of pesticides.
Documentation for the Survey of Pesticide Use During the Gulf War: The Survey Instrument — 2000
Survey dataset includes notes and text fields
Psychological and Psychosocial Consequences of Combat and Deployment with Special Emphasis on the Gulf War — 2001
Research in the neurosciences has demonstrated that the boundary between the external world (its events, pressures, concerns, and stress) and the brain and body has been broken. The concept of anything being "all in the mind" is scientifically and intellectually dead. While some data remain ambiguous and direct causal effect cannot be given to "stress" per se, the overall patterns of research findings demonstrate that stress is a contributing factor to many illnesses, including somatic and psychological symptoms. Therefore, very real consequences attend those who experience prolonged subacute chronic stress, which characterized the Gulf deployment, combat, and return home.
It is feasible that the effects of these stresses made some soldiers more vulnerable to environmental pathogens, both in the theater and at home, than they would otherwise have been. The symptoms of such insults, nested in sociocultural beliefs about illness and the Gulf, might well have amplified deleterious somatic consequences. Like many illnesses, those pertaining to service in the Gulf have been culturally shaped. An illness narrative describes the causes of the illness as perceived by the patient and is most often constructed out of the assertions, metaphors, folklore, causal attributions, and adduced causes common in the patient's culture. Other agents of a narrative's construction may be the media, friends, a variety of presumed authorities, the Internet, and support and self-help groups.
Such illness narratives can become an important factor in shaping both the nature and interpretation of symptoms by the patient. A cogent, widespread, and widely shared illness narrative is certainly a characteristic development of Gulf War illnesses. The threads of combat and deployment stress and the wide spectrum of possible responses, as demonstrated throughout history, weaves into the matrix of possible illness causation. It is also possible that a subset of the population is (in some ways, not yet understood) vulnerable and predisposed to injurious responses to the multiple stressors experienced in deployment and combat. This book argues that, to be most helpful to veterans, we must deal with this issue of complexity and not simply focus on a hypothecated or "hoped for" singular cause of Gulf War illness.
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