From AxisofLogic.com
U.S.
Military
Gulf War syndrome
revisited
By Vicki Brower
Nov 28, 2004,
05:13
As troops
returned home from the war in Iraq in late April, many wondered
whether some would soon fall ill, as did thousands of those who
fought in the first Gulf War (GWI) in 1991. During the past 12
years, nearly half of the 700,000 GWI veterans have sought treatment
for a wide range of symptoms that many suspect were linked to
exposure to depleted uranium, pesticides, vaccines, particulate
matter and gases from burning oil wells, biological and chemical
weapons, and the anti-nerve-gas drug pyridostigmine bromide (PB).
About 29% of soldiers who were deployed are now considered to
be disabled due to their wartime service, 23% are receiving
disability benefits, and tens of thousands of the rest are still
plagued by illness, but do not fall into these categories because of
the lack of a clear-cut diagnosis.
For more than a decade, soldiers were told that no
single cause, except stress, could explain complaints as diverse as
headaches, dizziness, fatigue, bone and joint pain, memory loss,
problems with sleep and concentration, muscle weakness, skin rashes
and sores, and gastrointestinal problems. The US government cited
statistics that showed that GWI veterans were not dying or being
hospitalized at higher rates than other soldiers. However, it could
not explain how stress could wreak such havoc on health, or why GWI
veterans were being diagnosed with amyotrophic lateral sclerosis
(ALS) at twice the rate of other groups. But new research is putting
the stress diagnosis to rest and, after 12 years of desperation for
the veterans, answers to the mystery surrounding GW syndrome are
being found. This should lead not only to effective treatments, but
also to more protection for soldiers and the general population
against future military and terrorist attacks.
In June 2002, the 12-member Research Advisory
Committee (RAC) on Gulf War Veterans' Illnesses released an interim
report that brought together studies pointing to several types of
neurological damage in the afflicted veterans (http://www.va.gov/RAC-GWVI). In the following
October, the US government's
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| "The
[US] government is finally realizing that the nature of war is
changing, and that soldiers can be damaged by weapons other
than bullets and bombs" |
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| Department of Veterans Affairs (DVA) made a
180-degree turnaround by publicly acknowledging that strong evidence
exists that many GWI veterans are suffering from brain damage caused
by different combinations of exposure to toxins. Deputy Secretary
Leo Mackay Jr admitted in an address to the RAC that, in the past,
the US government had "a tin ear, cold heart and a closed mind"
about toxic chemical exposure and drug–chemical interactions as
possible causes of GW syndrome. "The [US] government is finally
realizing that the nature of war is changing, and that soldiers can
be damaged by weapons other than bullets and bombs," said Steve
Robinson, Executive Director of the National Gulf War Resource
Center (NGWRC; Silver Spring, MD, USA; http://www.ngwrc.org),
a veterans' health advocacy group that was founded in 1995.
According to this organization, incidences of illness in
forward-deployed GWI units are higher than those in non-deployed
units; 42% of those who entered Iraq and Kuwait are ill, as compared
with 31% who served on land in support areas, and 21% who served on
ships. Length of service, as well as location, is also significant,
with longer tours correlating to more symptoms.
Along with earlier studies, evidence from research
funded by the US Department of Defense (DoD) and published in the
British Medical Journal (K. Ismail et al., 325,
576; 2002), was, said Mackay, undeniable. The study was conducted at
three London hospitals and followed 12,000 disabled British veterans
from the Bosnian and Gulf wars. The authors had previously
hypothesized that a psychological condition, similar to stress, was
the cause of GW syndrome, but the new study found that
"post-traumatic stress disorder is not higher in Gulf veterans than
in other veterans." Under the weight of this evidence, the DVA
pledged to double the budget for research into the illness to an
annual US $20 million. Another reason for the US government's
about-turn is the recognition that the biological and chemical
agents that the soldiers encountered in the desert in 1991 are the
ones that terrorists are threatening to use against the general
population, suggested Robinson.
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| ...the biological and chemical agents that the
soldiers encountered in the desert in 1991 are the ones that
terrorists are threatening to use against the general
population... |
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The Office of
the Special Assistant for Gulf War Illnesses (OSAGWI) was formed in
1997, but "it spent almost $250 million until 2002 without
publishing any med-ical research report or offering a single
treatment program for ill GW veterans," Robinson observed. Indeed,
in 1997, the General Accounting Office (GAO), the investigatory arm
of US Congress, reported that some researchers thought that they
would not receive funding for research into the syndrome because of
the DoD's position, and that it would be useless to try. Of the
research that has been performed, much of the groundbreaking work
was started about eight years ago by Robert Haley of Southwestern
Texas Medical School (Dallas, TX, USA), formerly at the Centers for
Disease Control (Atlanta, GA, USA). Initially, Haley was funded by
the Texan millionaire Ross Perot. Using magnetic resonance
spectroscopy, Haley and others showed evidence of neuronal loss in
the basal ganglia and brainstems of ill soldiers, and this research
is summarized in the RAC Interim Report. "Veterans with cognitive
problems show neuronal loss in the basal ganglia; those with muscle
and joint problems show loss in the brain stem," it states.
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| ...all three [GW] syndromes were strongly
associated with exposure to acetylcholinesterase
(AChE)-inhibiting organophosphates or
carbamates |
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In 1997, Haley
reported that there are three primary syndromes in GWI veterans:
syndrome 1 (impaired cognition) includes distractibility,
forgetfulness, depression and daytime somnolence; syndrome 2
(confusion-ataxia) is characterized by more profound reduced
intellectual processing, confusion, frequent disorientation and
episodes of vertigo; syndrome 3 (central pain) is characterized by
chronic somatic pain and parethesias of the extremities. Notably,
Haley reported that all three syndromes were strongly associated
with exposure to acetylcholinesterase (AchE)-inhibiting
organophosphates or carbamates. Syndrome 1 correlates to
organophosphate pesticides in flea collars; syndrome 2 correlates to
apparent low-level nerve agent exposure and advanced side-effects of
PB; and syndrome 3 is also associated with exposure to PB and high
concentrations of DEET insect repellant. Hans Kang, of the Central
Veterans Affairs Office, surveyed 20,000 samples from deployed and
non-deployed veterans from the GWI era and found three syndromes
closely resembling those identified by Haley. He concluded that
syndrome 2 was found only in the deployed GWI population and that
these patients were most likely to be unemployed due to their
symptoms. Research at the Hebrew University (Jerusalem, Israel) led
by Hermona Soreq, PhD, has shown that AChE-inhibitors induce the
long-term production of a variant form of an enzyme that is
associated with animals that have electrophysiological
hyperactivity, impaired working memory, hypersensitivity to head
injury and weakened muscles. Earlier work by her group showed that
PB crosses the blood–brain barrier more easily in stressed
animals.
Other key findings from
the affected veterans include an increased cold sensory threshold,
abnormal audiovestibular tests that reflect subtle damage to
brainstem reflex pathways and abnormal autonomic nervous system
function, which is shown by an atypical heart rate during sleep.
This could also explain the common complaints of poor sleep, morning
fatigue, chronic pathogen-free diarrhoea and an increase in
cholecystitis. Soldiers with syndrome 2, who had more brain cell
damage in the left basal ganglia, had higher levels of brain
dopamine production, a finding that is compatible with the
upregulation of dopamine receptors after damage to dopaminergic
pathways in basal ganglia.
Haley
and others also found a genetic component to GW syndrome. Compared
with a control sample, 26 affected veterans had much lower levels of
the enzymes paraoxonase (PON1) and butyrylcholinesterase (BChE),
which are responsible for inactivating organophosphates, and the
levels were particularly low in those with syndrome 2. Mutation of
the PON1 gene is also associated with the development of
Parkinson's disease (I. Kondo & M. Yamamoto, Brain
Research, 806, 271–273; 1998). Interestingly,
sheep-dippers in the UK that had fatigue–cognitive-pain syndromes
that are similar to GW syndrome and chronic fatigue syndrome, had
the same gene variant (N. Cherry et al., Lancet,
359, 763–764; 2002). Japanese researchers have cited the same
PON1 genotype in Asians as a possible explanation for the
high impact of the low-level sarin exposures in the 1995 terrorist
attack on the Tokyo subway. All these risk factors—exposures to
environmental toxins, genetics, low-level nerve agents, depleted
uranium, stress, medical countermeasures to bio- and chemical
weapons, and combinations thereof—are also relevant to domestic
terrorism preparedness, the report notes.
As in the Vietnam War, GWI was marked by poor
record-keeping of toxic exposures, and much of what was available
mysteriously disappeared, said Robinson. Veterans who became ill
after contact with Agent Orange in Vietnam struggled for years to
get the US government to acknowledge that contact had occurred and
had a corresponding direct and negative effect on their health. A
recent study stated that two million more gallons of Agent Orange
and other defoliants had been sprayed over Vietnam than earlier
estimates suggested (J.M. Stellman et al., Nature,
422, 681–687; 2003). GWI veterans face similar systematic
cover-ups of exposures to chemical weapons and other toxins,
according to congressman Chris Shays and others. In addition to
records being destroyed, soldiers who were given vaccinations and
prophylactic PB were not always told what they were taking. The US
government's position was that toxic exposures could not be verified
because sensors in the field were "unreliable." One source said that
when marines crossed Iraqi minefields to reach Kuwait during GWI,
they were exposed to poisonous gas. But with no accurate records, it
was impossible to say that GWI veterans were ill because of the
war-time exposures, the government said.
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| Only time will tell whether veterans of
the second Gulf War will suffer the same illnesses as those
from the first |
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In 1997, the
government finally admitted that soldiers were exposed to poisonous
gas when they bombed the Khamisiyah chemical depot during GWI. The
estimated numbers of those exposed started at 100, then rose to
10,000, then 15, 000, and finally reached 100,000. Last year, before
Michael Kilpatrick was moved from leading the OSAGWI to run the
public relations campaign for the second GW, he said that any
modelling to determine the exposure and dose rates of poisonous gas
at Khamisiyah or elsewhere was "a wild-ass guess"—and indicated that
the real number could be much higher than 100,000. Veterans who
served at Khamisiyah and Al Jubayl (another chemical depot that was
destroyed) are 37% more likely to have one or more service-connected
conditions than other veterans, according to the
NGWRC.
Despite efforts to cover
up the facts, the NGWRC maintains that more than 250,000 GWI
veterans received the drug PB, which was under investigation at the
time, and which the Pentagon now admits it cannot rule out as a
possible cause of GW syndrome. Eight thousand servicemen received
the botulinum toxoid vaccine, 150,000 received the now-controversial
anthrax vaccine, and 436,000 either entered or lived for months in
areas contaminated by more than 315 tons of toxic waste, possibly
containing trace amounts of highly radioactive plutonium and
neptunium, without awareness, protective gear or medical
evaluations. Hundreds of thousands lived outdoors near 700 burning
oil-well fires for months without protection.
Whether soldiers during the recent war in Iraq were
subject to the same or similar toxic exposures is an open question.
Only time will tell whether veterans of the second Gulf War will
suffer the same illnesses as those from the first. "If they do, the
cause this time will not be a mystery," Robinson said. "Now, the
only mystery connected to Gulf War syndrome is whether the
Department of Defense will do what Congress told them to do." Here,
he is referring to a 1998 US law that requires that soldiers receive
comprehensive physical examinations, including blood tests, before
and after deployment. Before the war began in March, the DoD
declared that it had learned from its mistakes; the troops were
being equipped with better environmental sensors and other testing
apparatus, and better gas masks and suits. It also said that it
would assess soldiers' health using brief questionnaires, before and
after deployment. However, the protective equipment was substandard
and, according to civilian health experts who testified in Congress
on March 25, 2003, once-yearly blood tests for HIV do not fulfil the
requirements for comprehensive examinations, which should include
lab tests and X-rays immediately before and after deployment. Two
days later, at the House Armed Services subcommittee, lawmakers
noted that many soldiers did not even fill out the questionnaires,
and Robinson said that those that did were likely to give answers
that would allow them to be deployed and remain with their units.
Twelve years after GWI, it seems that the military is making some of
the same mistakes again. However, the DoD stated on April 29, 2003,
that it would provide a more comprehensive, face-to-face examination
for the returning soldiers. Calling it a "first step", Robinson and
the NGWRC are still insisting that baseline data should have been
collected. Soldiers who are fighting terrorism around the world
should not experience the same system failures that GWI veterans
continue to face, he added.
http://www.nature.com/cgi-taf/DynaPage.taf?file=/embor/journal/v4/n6/full/embor874.html | |