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The Committee has examined exposure and, independently, expected health effects for ten Gulf War risk factors: pesticides, CW agents, BW agents, vaccines, PB, infectious disease, DU, oil-well fire smoke, petroleum products, and psychological and physiological stress. In our evaluation, we used the substantial amount of relevant scientific information available in published peer reviewed literature, interviews with experts, invited testimony, public comment, and discussions with scientific experts in academic and government agencies. For most of the risk factors evaluated, the Committee has determined-even in the absence of exposure data-they are unlikely to be associated with the health problems currently reported by Gulf War veterans. Based on its review, the Committee makes the following findings and recommendations.


Although some veterans clearly have service-connected illnesses, current scientific evidence does not support a causal link between the symptoms and illnesses reported today by Gulf War veterans and exposures while in the Gulf region to the following environmental risk factors assessed by the Committee: pesticides, chemical warfare agents, biological warfare agents, vaccines, pyridostigmine bromide, infectious diseases, depleted uranium, oil-well fires and smoke, and petroleum products. Some of these risk factors explain specific, diagnosed illness in a few Gulf War veterans, for example, leishmaniasis has been diagnosed in 32 individuals. Prudence requires further investigation of some areas of uncertainty, such as the long-term effects of low-level exposure to chemical warfare agents and the synergistic effects of exposure to pyridostigmine bromide and other risk factors.

A number of Gulf War risk factors-e.g., mustard agent, aflatoxin, and certain petroleum products-are potential human carcinogens that could cause increased rates of cancer beginning decades after exposure.

Stress is known to affect the brain, immune system, cardiovascular system, and various hormonal responses. Stress manifests in diverse ways, and is likely to be an important contributing factor to the broad range of physiological and psychological illnesses currently being reported by Gulf War veterans.


DOD and VA should perform long-term mortality studies of Gulf War veterans appropriate for investigating cancer rates in the Gulf War veteran population in the coming decades.

The entire federal research portfolio should place greater emphasis on basic and applied research on the physiologic effects of stress and stress-related disorders.

As noted, individuals in this group also were assessed for SCEs, which were found to increase with deployment to Kuwait and remain elevated even after the return to Germany.154 SCEs are a sensitive measure of DNA damage and repair and occur at a background rate in normal cells, but increase with exposures to DNA damaging agents. It is not clear what exposures in Kuwait could have led to the observed increases, since elevated SCEs are a nonspecific measure that can reflect exposure to infections and vaccinations, or to dietary, occupational, or environmental mutagens.

**In chapter 2, we identify those areas for which we believe new research data could fill in current gaps in knowledge.


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