Shrouded in sickness

Of the 697,000 U.S. troops who served in the 1990-1991 Persian Gulf War, about one in four suffer from illnesses related to the conflict, according to the Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC). Eighteen years later, many of these ailing veterans have symptoms for which no treatment has yet been found. RAC’s findings, released in November 2008, could help accelerate a search for medical relief by emphasizing that “studies consistently indicate” that Gulf War illnesses are not caused by combat stress, as some have suggested. In fact, the report points out that Gulf War vets have lower rates of post-traumatic stress disorder than veterans of other wars, and it accuses government officials of impeding the search for treatments by suggesting that stress is the main culprit. The low level of reported PTSD is not surprising, since the ground war only lasted four days. But in that brief conflict, an estimated 175,000 to 210,000 servicemembers might have encountered something that could jeopardize their health for the rest of their lives. What was to blame? Ironically, the advisory panel believes the most likely causes were defensive measures designed to protect the troops: pills to protect them against nerve agents and pesticides to protect from disease-carrying insects. The RAC report says, “The extensive body of scientific research now available consistently indicates that Gulf War illness is real, that it is the result of neurotoxic exposures during Gulf War deployment, and that few veterans have recovered or substantially improved with time.” While finding that evidence strongly indicates the pyridostigmine bromide (PB) pills used to protect troops against nerve agents and pesticides “are causally associated with Gulf War illness,” the report says other exposures cannot be ruled out. They include low-level exposure to nerve agents, close proximity to oil-well fires and inoculation with multiple vaccines. The multiple concurrent symptoms typically include some combination of chronic headaches, gastrointestinal problems, widespread pain, unexplained fatigue, chronic diarrhea, respiratory problems, skin rashes, and persistent memory and concentration problems. The RAC’s findings aren’t met entirely with agreement. A battle seems to be brewing between the RAC and the Institute of Medicine (IOM), which has authored nine congressionally mandated reports on Gulf War health issues. In response to VA’s request for an explanation of discrepancies between findings by the two groups, IOM President Harvey Fineberg responded that “most of the environmental hazards reviewed have not been found to explain illnesses experienced by Gulf War veterans.” He acknowledged the RAC report may have reached different conclusions due to access to more recent scientific studies and said that such a possibility would be explored in IOM’s review, scheduled for completion in February. The RAC drew heavily upon clinical and epidemiological studies of Gulf War veterans, as well as recent toxicological studies – some of which used methods that have only recently been developed, the committee says. Findings include observations of differences in the structure and function of the brains of ailing vets. Past routine medical evaluations often found no physical basis for the illnesses. Some researchers have also identified differences in the function of ill veterans’ autonomic nervous systems, which regulate involuntary physiological activities, such as circulation and breathing, and report that some vets have neuro-endocrine and immune alterations. VA is withholding judgment on the RAC’s conclusions. Lawrence Deyton, its chief public health and environmental hazards officer, says the agency won’t respond to the RAC report until the Institute of Medicine reviews it. “VA has traditionally, and by law, relied upon the IOM for independent and credible reviews of the science behind these particular veterans’ health issues,” he said in his statement for a May 19 congressional subcommittee hearing on Gulf War illnesses. DoD’s deputy director of force readiness and health assurance, R. Craig Postlewaite, also pointed to differing findings in his prepared statement for the hearing. He wrote that “based on many research studies, the IOM concluded that there are no unique symptoms or a unique pattern of symptoms in the veterans of that war.” Whatever the cause of the reported ailments, they have apparently not, at least at this point, shortened average life spans of veterans deployed during the Gulf War. The veterans do, however, have higher rates of amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease. Furthermore, an elevated rate of brain-cancer deaths has been reported in veterans who were potentially exposed to low levels of nerve agent when U.S. troops demolished Iraqi munitions caches at Khamisiyah in 1991. Only in 1996 did DoD announce that thousands of servicemembers might have been exposed to low levels of the nerve agents sarin and cyclosarin. Those chemicals can adversely affect the nervous system in ways similar to the effects of PB pills and pesticides. The effort to determine how many veterans may have been exposed to chemical agents was complicated by the postwar disappearance of many U.S. Central Command logs of reported chemical incidents, and limited capabilities of monitoring equipment. Even if the RAC is correct in pointing to the causes of illnesses, treatments remain undiscovered. Its report stresses the importance of further research in meeting that goal: “A clearer understanding is needed of how identified biological abnormalities contribute to veterans’ persistent symptoms, and how findings in different areas interrelate with one another. Most importantly, additional research is needed to determine how biological findings in veterans with Gulf War illness can be most usefully applied to identifying diagnostic tests and beneficial treatments.” The RAC report is among hundreds of studies and investigations of Gulf War illnesses. The U.S. government spent $340 million from 1994 to 2007 on projects identified as Gulf War research, mainly funded by DoD and VA. The RAC report questions the effectiveness of those explorations. “Substantial federal Gulf War research funding has been used for studies that have little or no relevance to the health of Gulf War veterans, and for research on stress and psychiatric illness,” it states. The RAC especially finds fault with IOM reports that “have particularly fallen short in advancing understanding of associations between Gulf War exposures and Gulf War illness.” The committee report does applaud a recent shift away from the focus on stress and psychiatric disorders, which it says began in 2006. A crucial aspect of that direction is a VA-funded center of excellence for Gulf War research at the University of Texas Southwestern. Focusing on identifying biological abnormalities associated with Gulf War illness is what may help develop diagnostic tests and treatment. Sick veterans continue to press for more research funding to find effective treatment. Paul Sullivan, executive director of Veterans for Common Sense, blames DoD and VA for lack of greater progress. In his statement for the May 19 subcommittee hearing, he wrote “While the Department of Defense and the Department of Veterans Affairs say they will assist our ill Gulf War veterans, the two agencies often fight against our veterans. The two agencies fight against scientific research into toxic exposures.” Is enough being done to find treatments that will cure all these symptoms? “As an ill Gulf War veteran who has worked on this issue for 17 years,” Sullivan wrote, “the answer is no. Absolutely not.” Margaret Davidson is a freelance writer and frequent contributor to The American Legion Magazine.