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Kenneth C. Hyams, MD, MPH
Naval Research Institute Bethesda, Md

F. Stephen Wignall, MD
Freeport Malaria Control and Public Health Timika, Irian Jaya, Indonesia

JAMA. 1997;278(5):384.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—In the 3-part study of a reserve naval mobile construction battalion by Dr Haley et al,^1-8 the hypothesis that wartime exposure to combinations of chemical agents caused neurologic injury among Gulf War veterans cannot be supported because of methodological limitations and the need for further clarification and analysis. The possibility of both selection and recall bias is an underlying limitation of all 3 studies because the initial population survey,¹ which categorized 63 veterans into 6 syndromes by factor analysis, relied on selfreported symptoms provided by a minority of eligible participants. Further analysis of potential biases is needed, including the reasons provided for nonparticipation.¹ In addition, the case definition of unexplained illnesses developed for the Department of Defense in 1994 does not provide a basis for comparison of the postulated syndromes.¹ This working definition was developed from the most common self-reported symptoms of a unique population (self-referred clinic . . . [Full Text PDF of this Article]

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