Examining Possible Causes of Gulf War Illness: RAND Policy Investigations and Reviews of the Scientific Literature

Veterans of the 1991 Persian Gulf War have reported a variety of physical and psychological symptoms, some of which remain unexplained. In an eff ort to do everything possible to understand and explain the illnesses, inform veterans and the public, and recommend changes in Department of Defense (DoD) policies and procedures to minimize such problems in the future, the Secretary of Defense in 1996 designated that a Special Assistant for Gulf War Illnesses and his offi ce (OSAGWI) oversee all DoD eff orts related to illnesses of Gulf War veterans. To complement its investigations, the OSAGWI commissioned the RAND National Defense Research Institute and RAND Health Center for Military Health Policy Research to examine the scientifi c literature and conduct other policy investigations on the health eff ects of eight areas of possible causes of illness. It was hoped that combining what scientifi c investigations had to say about what happened in the Gulf War would produce a more complete understanding of illnesses among veterans of that war. Th is research brief outlines RAND’s investigations into the health eff ects of infectious diseases, pyridostigmine bromide (PB), immunizations, wartime stress, chemical warfare and biological warfare (CW/BW) agents, oil well fi res, depleted uranium (DU), and pesticides. Many of these studies were scientifi c literature reviews that generally focused on information published or accepted for publication in peer-reviewed journals, books, government publications, and conference proceedings. RAND occasionally used unpublished information, but only to develop hypotheses. In a few instances, RAND commissioned independent investigations into the nature or extent of potential causes of Gulf War illness. Infectious Diseases A RAND review of the scientifi c literature examined known or plausible infectious diseases (with the exception of the fl u or common cold) that were actually diagnosed in people who served in the Gulf War or that are known to exist in the Persian Gulf area. Th e study found that the incidence of infectious disease was very low among U.S. troops in the Gulf War, and that known infectious diseases were properly diagnosed and treated. Th e study could not, however, rule out the possibility that some as-yet-unknown infectious diseases could have been a contributing cause to undiagnosed illnesses among Gulf War veterans. While most commonly recognized infectious diseases have been ruled out, one theory that continues to merit attention concerns the role of mycoplasma, This product is part of the RAND Corporation research brief series. RAND research briefs present policy-oriented summaries of individual published, peer-reviewed documents or of a body of published work.