Protecting the Health of U.S. Military Forces: A National Obligation

摘要

THE GULF WAR in 1991 was the last critical test of military medicine during full scale ground and air combat operations. By nearly all measures, this war was a victory not only for United States combat troops and its allies, but also for the military health care system (26). The Department of Defense (DoD) was able to deploy an extensive clinical care and preventive medicine infrastructure rapidly to a distant, desert environment (2). As a result of these efforts and prevention programs established before the war, the disease and non-battle injury rate among deployed U.S. forces was lower in this war than in previous major conflicts (10,11). Even more importantly, the number of combat deaths was much less than anyone had predicted, mainly because of the quick and decisive defeat of the Iraqi military by superior U.S. and allied forces (39). Despite the success of military medicine in the Arabian Gulf, the general perception 9 yr later is considerably different because of unresolved questions about the health of Gulf War veterans (31). In particular, veterans have experienced fatigue, joint pain, sleep problems, and other diverse symptoms that have not been definitively explained (15,28,37). Gulf War health questions have resulted in substantial controversy over potentially hazardous exposures during the deployment, the possibility of adverse affects from preventive health measures, and the role of stress in causing chronic illness (23,31). Although further research is in progress, an optimistic perspective on veterans. health already has been provided by an extensive research effort based on clinical evaluations and medical records (29). Systematic clinical examinations have not identified a unique syndrome or a characteristic organic abnormality among over 100,000 U.S., British, and Canadian Gulf War veterans (7, 22,27).