The committee has developed the following additional recommendations for research based on its review of the literature on each of the putative agents (Chapters 47). These recommendations highlight areas of scientific uncertainty and gaps in research.

DEPLETED URANIUM

While a group of veterans exist with depleted uranium in their tissues, the majority of veterans’ exposure to DU is unknown. The committee urges the continuation and expansion of efforts to model potential exposures to DU in various military settings (e.g., inside and outside vehicles damaged by DU munitions, other areas potentially contaminated by the dispersion of DU particles). Such efforts may result in a quantitative assessment of Gulf War veterans’ exposure to depleted uranium. Further, the committee urges publication of the results in the peer-reviewed literature so that the studies may receive broad review.

The committee recommends the following avenues of research to complement our current knowledge of the health effects of depleted uranium.

The committee recommends long-term follow-up of veterans exposed to depleted uranium, including the Baltimore cohort and other veterans potentially exposed to depleted uranium (e.g., those involved in cleanup operations or radiation control units).

Long-term follow-up of the cohort of veterans who have undergone evaluation at the Baltimore Veterans Administration (VA) Medical Center since 1993 will continue to improve our understanding of the health effects of exposure to depleted uranium. The committee recommends expanding the cohort of DU-exposed veterans and including control cohorts of non-DU-exposed Gulf War-deployed veterans in this study.

Additionally, controlled, long-term morbidity and mortality studies of additional cohorts of Gulf War veterans, particularly those that may have been exposed to DU through different routes of exposure (e.g., those involved in cleanup operations and in radiation control units), would further the knowledge on health effects related to DU exposure.

The committee recommends continued follow-up of the cohorts of uranium processing workers, particularly studies that will incorporate more sophisticated analyses of the data.

The majority of the evidence on the human health effects of exposure to uranium is from studies of workers in uranium processing mills and other facilities. These cohorts are a valuable information resource, as they are, in many cases, large groups that have been studied for many years. Additionally, researchers have analyzed data across several of these cohorts to enable comparisons between the cohorts and to increase the possibility of observing rare health outcomes. The



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