US Accused of Failing Ill 1991 Gulf War Veterans

Experts and senators accused the Pentagon and Veterans Affairs Department of failing to take seriously illnesses suffered by U.S. 1991 Gulf War veterans and doing too little to help them.
by Will Dunham

WASHINGTON, Sept 25 (Reuters) – Medical experts and U.S. senators accused the Pentagon and Veterans Affairs Department on Tuesday of failing to take seriously illnesses suffered by U.S. 1991 Gulf War veterans and doing too little to help them.

Expert witnesses called before the Senate Veterans Affairs Committee testified that Gulf War illnesses are real, serious and widespread among U.S. troops sent to expel Iraqi forces from Kuwait. The issue has been controversial for years.

The Institute of Medicine, which provides advice on medical issues to U.S. policymakers, concluded in September 2006 that Gulf War veterans reported far more symptoms of illness than their fellow troops who were not deployed.

But its report said studies have failed to establish that these symptoms constitute a medical syndrome unique to Gulf War veterans.

Some of the harshest criticism of the government came from members of an advisory committee created by Congress in 1998 to advise the VA on Gulf War illnesses…     

This panel's chairman, James Binns, said 16 years after the war, 175,000 U.S. veterans — one in four of those who served — remain seriously ill, with the sickest among them developing neurodegenerative diseases and brain cancer.

Binns said Pentagon and VA officials continue to "minimize these illnesses at every opportunity, misleading Congress and the scientific community." He faulted a VA fact sheet given to some senators stating, "Gulf War veterans suffer from a wide range of common illnesses, which might be expected in any group of veterans their age."

"That," Binns testified, "is garbage."

Lea Steele, scientific director for the advisory panel, said veterans with Gulf War illness typically experience some combination of severe headaches, memory and concentration problems, persistent pain, fatigue, gastrointestinal and respiratory problems and unusual skin lesions and rashes.

CAUSES UNCLEAR

The causes remain contentious, with some of the possibilities often cited including: low-dose exposure to chemical weapons, vaccines or medications given by the military, pesticides or smoke from burning oil wells.

Republican Sen. Richard Burr of North Carolina cited a consensus among Veterans Affairs committee members that Gulf War illnesses are real. Washington state Democratic Sen. Patty Murray blasted the Pentagon's "long and shameful history" of failing to help the ill veterans.

A Pentagon health official said 15 to 20 percent of U.S. troops deployed to fight the current wars in Afghanistan and Iraq are coming home with "ill-defined" medical symptoms that defy standard diagnosis, as was the case with Gulf War vets.

"I don't want to say we're seeing Gulf War illness in these folks," the Pentagon's Dr. Michael Kilpatrick said after the hearing, but added that some symptoms are similar to those seen in the earlier Gulf War veterans.

Binns said the U.S. government has spent more than $300 million on Gulf War illness research.

"Much of the money was misspent on the false theory that these illnesses were caused by psychological stress, part of a deliberate effort to downplay these illnesses as the sort of thing that happens after every war, rather than the result of toxic exposures," Binns said.

"Only two treatment studies have ever been conducted, with negligible results. This is a tragic record of failure, and the time lost can never be regained," Binns said.

Kilpatrick said the 1991 Gulf War veterans who report health problems are definitely ill, but do not have a single type of health problem. "There isn't any constellation of symptoms that's unique to Gulf War veterans," he added.

WHAT CAUSED GULF WAR SYNDROME?

Gulf war syndrome still eludes science

Soon after returning from the Persian Gulf war in 1991, U.S. veterans began complaining of strange symptoms: fatigue, joint pains, memory loss. The complaints were hard to dismiss — after all, these soldiers had been in combat-ready condition when they were shipped east to drive Iraq's army from Kuwait.

At first, the Pentagon denied that the syndrome existed, then asserted that it could have been caused by war-time chemical exposure. Although Iraq had repeatedly warned of its willingness to use chemical weapons, there was no hard evidence that it did. Nor could the incineration of Kuwait's oil fields have caused the problem, since many of the ill vets had not been exposed to the huge clouds of petro-fumes.

On Oct. 9, 1996, a prestigious committee of the National Academy of Science's Institute of Medicine concluded that there was no evidence for a mysterious chronic illness associated with Persian Gulf War service.

All ahead reverse!
The report barely hit the headlines when the dam broke. One revelation after another bespoke the possibility that some combination of toxic chemicals or biological agents had caused the syndrome.

It turned out that a major Iraqi ammunition dump detonated by U.S. soldiers had contained nerve gas, and that Gulf-War symptoms were appearing in ever-more vets.

After the Pentagon shifted into reverse and admitted that its vets were not simple malingerers, it turned gulf war syndrome into a heavily researched — and exceedingly frustrating — medical conundrum. Soldiers in the Gulf region were exposed to a bewildering variety of nasties: oil smoke, nerve gas, vaccines, depleted uranium, fuel, insecticides, anti-nerve-gas medicines — in addition to the usual dislocation, boredom, exhilaration and terror of wartime.

"Gulf war syndrome" now encompasses two broad categories of complaints:

Neurological symptoms — fatigue, memory loss, difficulty concentrating and sleep disturbances, and physical symptoms — digestive problems, joint pain, and heart and circulatory difficulties.

As we write in 2001, the U.S. government has spent $155 million researching the syndrome, and nobody can say for certain what caused gulf war syndrome — or indeed whether it is a unique medical entity rather than a bundle of diseases seen after other wars but called by other names.

The 1996 announcement that broke the dam of skepticism concerned the destruction of the giant Kamisiyah ammunition dump in southern Iraq on March 4, 1991, the day after Iraq surrendered. To destroy the arsenal, members of the 37th Engineering Battalion had set explosives under rockets that, unknown to them, contained the deadly nerve gas Sarin. The evidence of possible contamination began spreading like nerve gas across a desert battlefield:

The Pentagon announced that a pit holding at least 300 rockets containing sarin and cyclosarin, a related compound, had been demolished March 10.

The New York Times reported that Kamisiyah had been bombed extensively before the ground campaign, meaning GIs could have been exposed before their assault (see "U.S. Jets…" in the bibliography.)

The Pentagon continued to raise its estimate of the number of downwind troops who might have been exposed to chemical weapons during demolition efforts.

The Kamisiyah dump contained up to seven tons of sarin, according to press reports. Since it takes just a millionth of a gram of sarin to kill, that amount could, theoretically, kill millions. The only "good" data on Sarin's human toxicity come from a subway-poisoning episode in Tokyo, but the high doses in the subway may not shed much light on the low doses the GIs got in the desert (see "Sarin Savagery" in the bibliography).

Still, the revelations provided a possible material basis for the syndrome. Politicians of both parties, and activists who had pushed for action on gulf war syndrome, quickly demanded research, treatment and compensation.

Another question-mark
Five years later, the issue remains about as intractable as ever. Nobody can explain what combination of insults — whether from vaccines, toxins or pathogens — caused the syndrome. As researchers desperately chase an elusive target, some have advocated far-fetched theories about causes and treatments.

In 1997, Robert Haley, an epidemiologist at the University of Texas Southwestern Medical Center, published studies that differentiated three components of gulf war syndrome:
– memory, attention and reasoning;
– confusion and balance;
– and muscle aches and weakness.
Haley correlated each of these syndromes with specific chemical exposures, but critics questioned his small sample and lack of controls.

Edward Hyman, a retired New Orleans doctor, thinks gulf war syndrome reflects a chronic bacterial infection. Hyman got $3.4 million in 1996 direct from Congress to study 36 people, but he has yet to publish his results. Apparently, he failed to use standard double-blind procedures to reduce bias.

A southern California researcher, Girth Nicholson, also received $3.4 million to study 491 gulf war patients, who will get either a placebo or an antibiotic. Like Hyman, Nicholson attributes the syndrome to an infection that can only be cleared by long-term antibiotic treatment.

Behind the disputes over gulf war syndrome is a long-standing argument over the effects of low doses of chemicals. At one extreme are those who believe exposure to many chemicals can lead to multiple chemical sensitivity. At the other, many scientists say that if an effect is not been measured in the lab, it doesn't exist.

Still, veterans take gulf war syndrome seriously. By 1996, an estimated 50,000 to 60,000 U.S. veterans had sought medical evaluation for the syndrome from doctors in the military or Department of Veterans Affairs.

But in 2001, despite continuing studies, the existence and cause of gulf war syndrome are both in question. At a meeting in Virginia in January, 2001, John Feussner, the top research official in the Department of Veterans Affairs, told Science magazine, "We're going to look as long as there's a chance we're going to find something."

Science reported that researchers reported no major insights at the 2001 meeting, and seemed to accept that the conundrum might be insoluble (see "Gulf War Illness: the Battle Continues" in the bibliography).

In their heads?
It's possible — although anathema to many gulf war activists — that gulf war syndrome is the name for a more generalized post-war syndrome. After World War I, the lingering effects of war were called "shell shock"; after World War II, "battle fatigue," and after the U.S. war in Vietnam, "post-traumatic stress syndrome."

According to this theory, gulf swar syndrome is a more heavily publicized and intensely researched version of the physical and psychological impact of waging war.

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