Mr. Chairman and distinguished Members of the Sub-Committees, it is a pleasure for us to address you today on RAND's review of the scientific literature as it pertains to pyridostigmine bromide (PB) and illnesses among Gulf War veterans. RAND was asked to perform a literature review to evaluate whether PB could plausibly be related to increased health symptoms experienced by Persian Gulf War (PGW) veterans. I examined over 10,000 titles, 6,000 abstracts, several thousand papers and reports, interviewed over 80 people, and reviewed dozens of declassified British studies and reports.

This literature review, one of eight commissioned by the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses, summarizes the existing scientific literature on the health effects of pyridostigmine bromide that may have affected service members who served in Operations Desert Shield and Desert Storm. The eight RAND reviews are intended to complement efforts by the Defense Department and other federal agencies in their attempt to understand the full range of health implications of service in that conflict. --p. v. of Preface.

This literature review, one of eight commissioned by the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses, summarizes the existing scientific literature on the health effects of pyridostigmine bromide that may have affected service members who served in Operations Desert Shield and Desert Storm. The eight RAND reviews are intended to complement efforts by the Defense Department and other federal agencies in their attempt to understand the full range of health implications of service in that conflict. --p. v. of Preface.

In January 1995 the Institute of Medicine released a preliminary report containing initial findings and recommendations on the federal government's response to reports by some veterans and their families that they were suffering from illnesses related to military service in the Persian Gulf War. The committee was asked to review the government's means of collecting and maintaining information for assessing the health consequences of military service and to recommend improvements and epidemiological studies if warranted. This new volume reflects an additional year of study by the committee and the full results of its three-year effort.

The confrontation that began when Iraq invaded Kuwait in August 1990 brought with it the threat that chemical and biological weapons might be used against the more than half a million military personnel the United States deployed to the region. To protect these troops from such threats, the Department of Defense wished to use drugs and vaccines that, not having been tested for use in these specific situations, were considered "investigational" by the federal Food and Drug Administration. This report examines the history of the Interim Rule, adopted in December 21, 1990, that authorized the Commissioner of Food and Drugs to waive informed consent for the use of investigational drugs and vaccines for certain military uses; how this authority was used for pyridostigmine bromide and botulinum toxoid during the Gulf War; and the subsequent controversy surrounding the rule, its application, and its implications.

The sixth in a series of congressionally mandated reports on Gulf War veterans' health, this volume evaluates the health effects associated with stress. Since the launch of Operation Desert Storm in 1991, there has been growing concern about the physical and psychological health of Gulf War and other veterans. In the late 1990s, Congress responded by asking the National Academy of Sciences (NAS) to review and evaluate the scientific and medical literature regarding associations between illness and exposure to toxic agents, environmental or wartime hazards, and preventive medicines or vaccines in members of the armed forces who were exposed to such agents. Deployment to a war zone has a profound impact on the lives of troops and on their family members. There are a plethora of stressors associated with deployment, including constant vigilance against unexpected attack, difficulty distinguishing enemy combatants from civilians, concerns about survival, caring for the badly injured, and witnessing the death of a person. Less traumatic but more pervasive stressors include anxiety about home life, such as loss of a job and income, impacts on relationships, and absence from family. The focus of this report, by the Institute of Medicine (IOM) Committee on Gulf War and Health: Physiologic, and Psychosocial Effects of Deployment-Related Stress, is the long-term effects of deployment-related stress. Gulf War and Health: Volume 6. Physiologic, and Psychosocial Effects of Development Related Stress evaluates the scientific literature regarding association between deployment-related stressors and health effects, and provides meaningful recommendations to remedy this problem.

Many veterans returning from the conflicts in Iraq and Afghanistan have health problems they believe are related to their exposure to the smoke from the burning of waste in open-air "burn pits" on military bases. Particular controversy surrounds the burn pit used to dispose of solid waste at Joint Base Balad in Iraq, which burned up to 200 tons of waste per day in 2007. The Department of Veterans Affairs asked the IOM to form a committee to determine the long-term health effects from exposure to these burn pits. Insufficient evidence prevented the IOM committee from developing firm conclusions. This report, therefore, recommends that, along with more efficient data-gathering methods, a study be conducted that would evaluate the health status of service members from their time of deployment over many years to determine their incidence of chronic diseases.