The Health impact of chemical exposures during the Gulf War: a research planning conference

In: http://stacks.cdc.gov/view/cdc/12073/

Abstract

On February 28 through March 2, 1999, the Centers for Disease Control and Prevention (CDC) and other agencies of the Department of Health and Human Services (HHS) brought together scientists, clinicians, veterans, veterans' service organizations, Congressional staff, and other interested parties to discuss and make recommendations regarding the direction of future research on undiagnosed illnesses among Gulf War veterans and their links with multiple chemical and environmental exposures. The format for the conference included plenary sessions, concurrent workgroups, and a veterans' forum. The plenary sessions were meant to provide background information and to stimulate dialog on research questions. The plenary sessions included an overview of research findings regarding the health impact of the Gulf War, a panel discussion of the experience of Gulf War veterans, a series of presentations on the possible health outcomes of low-level chemical exposures focusing on nervous system, immune system, and pulmonary system outcomes, a series of panel discussions on research and clinical findings regarding multiple chemical sensitivity among Gulf War veterans and civilian populations, a series of presentations on possible mechanisms of action of chemical exposures, and a panel discussion on methodological considerations in studying the health impact of chemical exposures during the Gulf War. The concurrent workgroups were asked to develop research recommendations in four areas: pathophysiology, etiology, and mechanisms of action; assessment and diagnosis of illnesses; treatment; and prevention of illnesses in future deployments. Each workgroup was asked to develop research recommendations that addressed specific issues. For the pathophysiology workgroup, these issues included synergistic and subclinical effects of chemicals, genetic susceptibility, biomarkers of susceptibility and exposure, and appropriate study methods. The assessment and diagnosis workgroup was asked to focus on case definition, overlap of conditions, the role of chronic multi-system conditions, biomarkers of illness, optimal methods for assessment and diagnosis, and validation of assessment approaches. The treatment workgroup was asked to focus on appropriate treatment paradigms, rehabilitation approaches, health care opportunities, education of physicians, and appropriate study methods. The prevention workgroup was asked to focus on health education and risk communication, approaches to environmental assessment, biomonitoring, and health preparedness. The workgroups were free to use whatever approach they found useful for developing research recommendations. In some cases there was considerable disagreement among workgroup members on the direction of the recommendations. Thus, the final recommendations of the workgroups were not necessarily endorsed by all workgroup members. This report summarizes the outcome of each of the four workgroup sessions. Chapters 2 - 5 present the recommendations as developed by the workgroups. Although the workgroups were asked to focus on research recommendations, some recommendations reflect clinical care, administrative, or policy issues. No attempt was made to filter non-research recommendations from this report. Chapter 6 provides a discussion of the workgroup deliberations and attempts to place the recommendations in the context of current Gulf War research activities. The recommendations developed at this conference represent the deliberations of the workgroup participants and do not necessarily imply endorsement by the veteran or scientific community as a whole or by the federal government. While some of the recommendations could be implemented in the short-term, many of the recommendations reflect long-term goals requiring significant restructuring of current systems and are unlikely to be easily implemented, especially in the time frame requested by Gulf War veterans. Some of the recommendations may not be feasible, given current federal regulations. Other recommendations reflect initiatives that have already been instituted by federal agencies responsible for the care of veterans. ; sponsored by Centers for Disease Control and Prevention (CDC) in coordination with other offices and agencies of the U.S. Department of Health and Human Services (DHHS), Office of Public Health and Science, DHHS ; National Institutes of Health (NIH) and Agency for Toxic Substances and Disease Registry (ATSDR). ; Title from title screen (viewed Apr. 27, 2001). ; Mode of access: Internet. ; Includes bibliographical references (p. 34-42).