A Review of the Scientific Literature As It Pertains to Gulf War Illnesses

Volume 2: Pyridostigmine Bromide

by Beatrice A. Golomb


Full Document

FormatFile SizeNotes
zip file 1 MB

The file(s) provided above are ZIP-formatted archives, which most modern systems can natively unpack. If your computer does not unpack the archive when you double-click it, you may need to use a separate decompression program such as UnZip.


Purchase Print Copy

 FormatList Price Price
Add to Cart Paperback399 pages $30.00 $24.00 20% Web Discount

The United States and its allies in the Persian Gulf War (PGW) knew that Iraq had used nerve agents and chemical weapons in its previous conflicts and so took steps to protect their troops. Pyridostigmine bromide (PB) was distributed as a pretreatment that would enhance the effectiveness of postexposure treatments in the event that the nerve agent soman was used. This report examines the role that PB played in the ongoing chronic health problems documented in PGW veterans. After careful examination of the known effects of PB on the central and peripheral nervous systems, the author finds the evidence consistent with a possible role for PB as a contributor to the health complaints of some PGW veterans and calls for immediate attention in the form of additional investigation to clarify the role of PB.

Table of Contents

  • Preface

  • Figures

  • Tables

  • Summary

  • Acknowledgments

  • Abbreviations

  • Chapter One


  • Chapter Two

    Fact Sheet: PB Pretreatment for Soman Exposure

  • Chapter Three

    Characteristics of PB

  • Chapter Four

    PB Use in the Persian Gulf War

  • Chapter Five

    Health Problems in PGW Veterans

  • Chapter Six

    Theories Linking PB to Illness in Pgw Veterans

  • Chapter Seven

    Blood-Brain Barrier Passage

  • Chapter Eight

    Individual Differences in Reactions to PB

  • Chapter Nine

    Interactions Between PB and Other Exposures

  • Chapter Ten


  • Chapter Eleven

    Multiple Chemical Sensitivity

  • Chapter Twelve

    Neuromuscular Junction Effects

  • Chapter Thirteen

    Neurotransmitter Dysregulation

  • Chapter Fourteen

    Chronic Effects

  • Chapter Fifteen

    Other Considerations

  • Chapter Sixteen


  • Addendum

    Addendum: Evidence for Neurotransmitter Dysregulation Identified or Published Since the Review Process

  • Appendix A

    Pyridostigmine Pharmacokinetic Data

  • Appendix B

    Effects of PB in Humans

  • Appendix C

    Further Discussion of the Acetylcholine-Serotonin Relationship

  • References

This research was sponsored by the RAND National Security Research Division and RAND Health.

This report is part of the RAND Corporation Monograph report series. The monograph/report was a product of the RAND Corporation from 1993 to 2003. RAND monograph/reports presented major research findings that addressed the challenges facing the public and private sectors. They included executive summaries, technical documentation, and synthesis pieces.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. For information on reprint and linking permissions, please visit the RAND Permissions page.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.