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IJE Advance Access published online on May 23, 2005
International Journal of Epidemiology, doi:10.1093/ije/dyi102
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2005; all rights reserved.
Accepted April 19, 2005

Original paper

Can epidemiology clear the fog of war? Lessons from the 1990-91 Gulf War

Matthew Hotopf 1* and Simon Wessely 1

1 King's Centre for Military Health Research (KCMHR), King's College London, UK

* To whom correspondence should be addressed.
Matthew Hotopf, E-mail: m.hotopf{at}iop.kcl.ac.uk


  Abstract

Despite over US \$200 million having been spent researching illnesses following the 1990-91 Persian Gulf War, the nature and cause of such illnesses remains controversial. In this narrative review, we discuss some of the methodological issues that have affected epidemiological studies on this topic. These include low-response rates, ascertainment bias, recall bias, problems identifying suitable control groups, and problems defining the outcomes to study. From this we argue that difficulties have arisen partly owing to the significant delay between the point at which illnesses were first identified by veterans and the reporting of epidemiological studies and that health surveillance should be routine following future deployments.

Keywords: Gulf war illness; military health.
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