Joseph S. Cassells, M.D., M.P.H.
Institute of Medicine
The National Academies
before a Joint Hearing of the
Oversight and Investigations Subcommittee
Committee on Veterans Affairs
U.S. House of Representatives
November 16, 1999
Good afternoon, Mr. Chairman, and distinguished members of the subcommittee. Thank you for the opportunity discuss the Institute of Medicine’s (IOM) activities involving the war in the Persian Gulf, specifically the health effects of service in that operation. Since the particular focus of this hearing is pyridostigmine bromide and its possible relationship to Gulf War Illnesses, I will confine my remarks to that issue.
In 1995, an IOM Interim Report, Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action noted that there was little information about how PB, DEET, and permethrin might interact. Further, it was noted that interactions among those compounds are possible and are inadequately studied. (p15, Finding 12)
In the 1996 Final Report, Health Consequences of Service during the Persian Gulf War: Recommendations for Research and Information Systems, it is noted with regard to PB, "All of these possible drug interactions cause acute and short-term problems. The committee knows of no evidence of any chronic effect." Furthermore, the report goes on to conclude that “the number and variety of hypotheses call attention to the variety of different types of abnormalities that have been reported and the strong likelihood that no single hypothesis could account for all of these, whether or not the illnesses result from service in the Persian Gulf War."
The IOM, at the request of the Department of Veterans Affairs, is currently undertaking a literature review of chemical and biological compounds believed to have been present in the Gulf or as a result of the Gulf conflict. Phase 1 of this study is reviewing the literature on pyridostigmine bromide, sarin/cyclosarin, vaccines (botulinum toxoid and anthrax) and depleted uranium. Phase 2 will examine additional exposures.
At this time, the IOM has no comment regarding the RAND report, other than to note that any new report should be viewed with reservations until it has had careful attention from the rest of the scientific community. Evidence that seems to support a favored idea or hypothesis must be viewed with at least as much caution as evidence against that idea. The RAND report will be included in the literature review on pyridostigmine bromide. The report on the Phase 1 reviews will be available in August of next year
Despite media reports regarding the previous IOM report, noting that the committee is unaware of evidence of chronic effect related to PB, doesn’t mean that there is no relationship between PB and a long-term health effect and does not mean that a previous IOM committee ruled it out. Rather, there was not sufficient evidence at the time to determine an association.