Institute of Medicine Report

Graphic by Doc


NOTE that althought this report is entitled "Gulf War and Health" the report states "deployment to a WAR ZONE not specifically just the Gulf War.


INSTITUTE OF MEDICINE RELEASES REPORT, "GULF WAR AND

HEALTH, VOL. 6" -- Finds sufficient evidence to associate

deployment in a war zone with PTSD, depression,

alcohol abuse, marital conflict and suicide.






The full Institute of Medicine report is available here...

http://www.nap.edu/catalog.php?record_id=11922#toc

For more about the Institute of Medicine, use the VA Watchdog search engine...click here...

http://www.your vabenefits.org/sessearch.php?q=institute+of+medicine&op=ph

A summary of the report's conclusions, including recommendations, is below:

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SUMMARY OF CONCLUSIONS

Table S.1 provides a summary of the committee’s conclusions for each health effect discussed in the report by category of association. No health effects were found for two categories of association, sufficient evidence of a causal relationship and limited but suggestive evidence of no association. Of all the long-term health effects reviewed, the strongest findings were on psychiatric disorders, including PTSD, anxiety, and depression. Alcohol abuse, suicide and accidental death in the early years after deployment, and marital and family conflict also appear to be adverse sequelae of deployment-related stress.

The committee found limited but suggestive evidence of an association between deployment-related stress and chronic fatigue syndrome, fibromyalgia and chronic widespread pain, gastrointestinal symptoms, skin disorders, incarceration, drug abuse, and increased symptom reporting, unexplained illness, and chronic pain.

Finally, it should be repeated that the committee was charged with reviewing scientific data, not with making recommendations regarding VA policy.

Sufficient Evidence of a Causal Association

Evidence from available studies is sufficient to conclude that there is a causal relationship between deployment to a war zone and a specific health effect in humans. The evidence is supported by experimental data and fulfills the guidelines for sufficient evidence of an association (below). The evidence must be biologically plausible and satisfy several of the guidelines used to assess causality, such as strength of association, dose-response relationship, consistency of association, and temporal relationship.

• No effects.



Sufficient Evidence of an Association

Evidence from available studies is sufficient to conclude that there is a positive association. That is, a consistent positive association has been observed between deployment to a war zone and a specific health effect in human studies in which chance and bias, including confounding, could be ruled out with reasonable confidence. For example, several high-quality studies report consistent positive associations, and the studies are sufficiently free of bias and include adequate control for confounding.

• Psychiatric disorders, including PTSD, other anxiety disorders, and depressive disorders.

• Alcohol abuse.

• Accidental death in the early years after deployment.

• Suicide in the early years after deployment.

• Marital and family conflict.



Limited but Suggestive Evidence of an Association

Evidence from available studies is suggestive of an association between deployment to a war zone and a specific health effect, but the body of evidence is limited by the inability to rule out chance and bias, including confounding, with confidence. For example, at least one high-quality study reports a positive association that is sufficiently free of bias, including adequate control for confounding, and other corroborating studies provide support for the association (corroborating studies might not be sufficiently free of bias, including confounding). Alternatively, several studies of lower quality show consistent positive associations, and the results are probably not due to bias, including confounding.

• Drug abuse.

• Chronic fatigue syndrome.

• Gastrointestinal symptoms consistent with functional gastrointestinal disorders, such as irritable bowel syndrome or functional dyspepsia.

• Skin disorders.

• Fibromyalgia and chronic widespread pain.

• Increased symptom reporting, unexplained illness, and chronic pain.

• Incarceration.



Inadequate/Insufficient Evidence to Determine Whether an Association Exists

Evidence from available studies is of insufficient quantity, quality, or consistency to permit a conclusion regarding the existence of an association between deployment to a war zone and a specific health effect in humans.

• Cancer.

• Diabetes mellitus.

• Thyroid disease.

• Neurocognitive and neurobehavioral effects.

• Sleep disorders or objective measures of sleep disturbance.

• Hypertension.

• Coronary heart disease.

• Chronic respiratory effects.

• Structural gastrointestinal diseases.

• Reproductive effects.

• Homelessness.

• Adverse employment outcomes.



Limited but Suggestive Evidence of No Association

Evidence is consistent in not showing a positive association between deployment to a war zone and a specific health effect after exposure of any magnitude. A conclusion of no association is inevitably limited to the conditions, magnitudes of exposure, and length of observation in the available studies. The possibility of a very small increase in risk after deployment cannot be excluded.

• No effects.



RECOMMENDATIONS

The committee recommends that DOD conduct predeployment and postdeployment screening for medical conditions, including psychiatric symptoms and diagnoses, and for psychosocial status to help collect direct evidence about the causal nature of the effects of deployment-related stress. Predeployment screening would also help to identify at-risk personnel who might benefit from targeted intervention programs during deployment and would establish a baseline against which later health and psychosocial effects could be measured after deployment. Postdeployment screening and assessment would provide data that could be analyzed to determine the long-term consequences of deployment-related stress and would allow VA and DOD to implement intervention programs to assist deployed veterans in adjusting to postdeployment life. Such assessments should be made shortly after deployment and should identify those exposures most stressful to the veteran. The assessments should be made at regular intervals thereafter (such as every 5 years) to identify the long-term health and psychosocial effects. The committee further recommends that any longitudinal assessments also be conducted in a representative group of nondeployed veterans to allow appropriate comparisons between deployed and nondeployed veterans regarding health and psychosocial effects.

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Larry Scott --