The Last Word on Gulf War Illnesses? 

On Sunday, December 3, 2006, the Washington Post ran a front-page article on Gulf War Illnesses by David Brown that was filled with errors.  An estimated 200,000 veterans of the first Gulf War have the condition, according to the VA expert committee charged with making recommendations for research on it to the Department of Veterans’ Affairs.

The title of the article, “Funding Continues for Illness Scientists Dismiss” is dead wrong:  neither the scientific community nor the Institute of Medicine has concluded there is no Gulf War illness.  Instead, in September the Institute of Medicine said, “Veterans of the first Gulf War report significantly more symptoms [and more severe symptoms] of illness than soldiers of the same period who were not deployed, [but] studies have found no cluster of symptoms unique to Gulf War veterans.”  The Institute acknowledged that Gulf War veterans have several times the expected rates of fibromyalgia and chronic fatigue syndrome as other veterans, as well as other symptoms.  Their illnesses are simply not unique.

This comes as no surprise to doctors, who understand the body has only limited ways it can respond to a huge number of insults.  Lung cancer can result from tobacco smoke or asbestos or uranium.  Why should the illnesses of Gulf veterans be unique, anyway?

Dr. Robert Haley, head of epidemiology at the University of Texas Southwestern Medical Center in Dallas, received a renewable 15 million dollar grant to explore the role of nerve gas and related compounds in the illnesses of Gulf War veterans.   Haley’s research is based on the reasonable hypothesis that exposure to organophosphates (such as sarin) led to neurological symptoms in vets. However, Post author David Brown said there is a “scientific consensus against” Haley.  Brown further claims, “air containing the vaporized compound drifted over troops, but there is no evidence that anyone actually came in contact with sarin.”

Did troops get exposed to sarin when it drifted over their heads?  During combat operations, chemical monitors went off repeatedly, signifying the material did reach troop level.  Yet studies of troops exposed to sarin at Khamisiyah have been less than revealing.  However, in 2003 the GAO reported, “DOD’s conclusion, based on the findings of epidemiological studies—that there was no significant difference between rates of illness for exposed versus not exposed troops—is not valid” and “DOD and CIA plume modeling results are not reliable.”  If you can’t identify which troops were actually exposed, it's impossible to measure the effects of an exposure.  No wonder some studies don't support Haley.

Might low levels of sarin, or similar toxic substances that troops were exposed to (pesticides, flea collars, nerve agent pretreatments) collectively lead to later illness?  Brown says, “evidence that low-level exposure to sarin can lead to chronic illness is sparse,” and “there is also little evidence that simultaneous exposure to toxins has lasting effects.”  Yet Abou-Donia’s group at Duke found that multiple low-level exposures can be extremely damaging to animals.  A 2003 paper studying combinations of pesticides used by soldiers: malathion, DEET and permethrin, found  “exposure to real-life doses produce no overt signs of neurotoxicity but induce significant neurobehavioural deficits and neuronal degeneration in brain.”

Did the researchers cited by Brown actually tell him Gulf War veterans were no sicker than their peers?  Let’s review their publications. 

Wessely’s study of 4200 British Gulf War veterans (whose vaccinations were recorded, unlike US soldiers) found, “Service in the Gulf was associated with various health problems over and above those associated with deployment… a specific mechanism may link vaccination against biological warfare agents and later ill health.”

Gray found Gulf War veterans had an increase in multi-symptom conditions, mental health diagnoses, musculoskeletal disorders and injuries, especially those due to vehicular accidents, suggesting neurocognitive impairment. 

Feussner was an investigator in two large treatment studies of Gulf War veterans.  How could he investigate treatments for an illness if it didn’t exist? 

David Brown has this story all wrong.  

The VA’s Research Advisory Committee on Gulf War Veterans’ Illnesses summarized current findings on these illnesses in its 2004 report:

“A substantial proportion of veterans of the 1990-1991 Gulf War continue to experience chronic and often debilitating conditions characterized by persistent headaches, cognitive problems, somatic pain, fatigue, gastrointestinal difficulties, respiratory conditions and skin abnormalities…Research studies conducted since the war have consistently indicated that psychiatric illness, combat experience, or other deployment-related stressors do not explain Gulf War veterans’ illnesses in the large majority of ill veterans…Contrary to previous assumptions, exposure to nerve agents at levels too low to produce acute symptoms can result in chronic adverse effects on the nervous and immune systems.”  

The report called for long-term safety studies of anthrax vaccine, and of combinations of exposures.  Finally, the report noted that “Progress in understanding Gulf War veterans’ illnesses has been hindered by lack of coordination and availability of data maintained by DOD and the Department of Veterans’ Affairs.”

We owe it to Gulf veterans and to soldiers deployed today to get this story right.  It’s time to release the missing records, use the data they provide to research the effects of different exposures, including vaccines, and avoid the harmful exposures in future deployments.  Finally, identifying effective treatments for these complex, multi-symptom illnesses is overdue.

Meryl Nass, MD 

Meryl Nass is a physician who treats ill Gulf War veterans and has testified before Congress and the Institute of Medicine on Gulf War illnesses. 

Updated: December 9th, 2006