Gulf War Veterans Measuring Health (1999) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-11
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The federal government has spent more than $230 million to fund research efforts and diagnostic programs to answer the many questions raised. Research studies have compared Gulf War veterans to other contemporary military veterans to determine whether they have higher hospitalization rates *
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The findings of these studies, evidence from the many efforts to evaluate Gulf War veterans' health conducted by the aforementioned bodies, and additional independent research support several conclusions: . No single diagnosable illness or set of symptoms with a known etiology characterizes either Gulf War veterans in general or a subset of veterans who are experiencing some kind of health problem.
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In addition, a workshop was held in May 1998 to obtain background information on the health concerns of Gulf War veterans and an overview of relevant research. During subsequent meetings the Committee reviewed and analyzed additional information on: symptoms, complaints, and diagnoses of veterans; completed populationbased and sample-survey research on the health of Gulf War veterans from the United States, Canada, and the United Kingdom; VA and DoD health databases; the reports of the PAC, the GAO, and other IOM committees; and books and articles describing and evaluating approaches to and instruments for measuring health status.
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What methodological questions should be considered regarding acquiring and analyzing longitudinal information? · What scientific studies should be conducted to resolve the areas of continued scientific uncertainty related to health outcomes and treatment efficacy in Gulf War veterans?
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How can we know if Gulf War veterans are ill due to something that happened in the Gulf War, since adequate exposure data or adequate data on their health at that time are not available? aFrom testimony presented by veterans and veterans organizations during congres sional hearings.
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Of fundamental importance is the need to know how many Gulf War veterans are suffering from health problems that affect their ability to function; whether the prevalence of such problems among Gulf War veterans is consistent with their prevalence among the general public or among other veterans groups; and whether the health of veterans is getting better, staying the same, or deteriorating with time. Because these fundamental questions address both the health of Gulf War veterans at specific time points and changes over time, the committee recommends that a prospective cohort study of the population of Gulf War veterans be conducted.
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Therefore, the committee recommends that multiple studies be initiated through a research portfolio with three components: population studies, health services research studies, and biomedical and clinical investigations. The committee recommends that a core set of data on health be collected in all studies and include measures of: · death and duration of life · ~ · Impairment, · functional status, · health perceptions, and · opportunity The capacity for health, the ability to withstand stress, and physiological reserve]
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Specif~cally, the committee recommends the prospective cohort study incorporate the following features: · multiple cohorts, one for each group of interest; · multistage sampling with initial cluster sampling followed by stratified random sampling within clusters; and · random and representative selection of participants within clusters; hypothesis-driven oversampling of specific population subgroups; and multiple modes of interviewing, including telephone and in-person interviewing. Although the committee is persuaded that a prospective cohort study is a necessary and appropriate method for monitoring the health of Gulf War veterans, it recognizes Eat such a study requires a major commi~nent of resources.
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Specifically, the committee recommends that an independent advisory board oversee the conduct of the prospective cohort study. The advisory board should · be an independent, scientific, and policy-oriented body composed of experts in clinical medicine, epidemiology, health status and health outcomes assessment; veterans' health issues; health services research; social, behavioral, physical, and biomedical sciences; survey research; statistics; national health databases; health policy; and members of the public who represent Gulf War veterans.
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Additionally, given the enormous amount of time, effort, and resources devoted to numerous studies of the health of Gulf War veterans, it is important that a mechanism be implemented to allow comparisons across these studies on key health correlates and health outcomes. The research portfolio recommended by the committee is designed to accomplish this.
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EXECUTIVE SUMMARY 1 1 the greatest scientific integrity and public accountability, the committee believes it is necessary to establish an independent advisory board to oversee the implementation of the prospective cohort study and related research portfolio, with periodic reports on these efforts to Congress.
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