Gulf War syndrome

Gulf War syndrome (GWS) or Gulf War illness (GWI) is the name given to an illness with symptoms including increases in the rate of immune system disorders and birth defects, reported by combat veterans of Operation Desert Storm during the Gulf War. It has not always been clear whether these symptoms were related to Gulf War service. Symptoms attributed to this syndrome have been wide-ranging, including chronic fatigue, loss of muscle control, diarrhea, migraines and other headaches, dizziness and loss of balance, memory problems, muscle and joint pain, indigestion, skin problems, and shortness of breath. U.S. Gulf War veterans have experienced mortality rates exceeding those of U.S. Vietnam veterans. Brain cancer deaths, amyotrophic lateral sclerosis (commonly known as Lou Gehrig's disease) and fibromyalgia now are recognized by the Defense and Veterans Affairs departments as potentially connected to service during the Persian Gulf War. [1]

At the December, 2005 Research Advisory Committee on Gulf War Veterans’ Illnesses meeting [2] the following potential causes were still being considered, others which have been suggested through the years having been ruled out:

• combstion products from depleted uranium munitions,
• side-effects from the early 1990s' anthrax vaccine,
• infectious diseases from parasites,
• chemical weapons such as nerve gas or mustard gas, and
• combinations of the above factors;

The following substances were found to be associated with increased GWI symptoms in combat soldiers, but have been ruled out except as confounding factors because the exposed non-combat cohort did not also develop symptoms:

• pesticides and insect repellents, and
• pyridostigmine bromide, a drug to protect against nerve agents. [3]

Medical problems by soldier nationality

The tables below apply only to coalition forces involved in combat. Since each nation's soldiers generally served in different geographic regions, epidemiologists are using these statistics to correlate effects with exposure to the different suspected causes. [4]

Excess prevalence of general symptoms:

Symptom	U.S.	U.K.	Australia	Denmark
Fatigue	23%	23%	10%	16%
Headache	17%	18%	7%	13%
Memory problems	32%	28%	12%	23%
Muscle/joint pain	18%	17%	5%	(-2%)
Diarrhea	16%		9%	13%
Dyspepsia/indigestion	12%		5%	9%
Skin problems	16%		8%	12%
Shortness of breath	13%		9%	11%

Excess prevalence of recognized medical conditions:

Conditon	U.S.	U.K.	Canada	Australia
Skin conditions	20-21%	21%	4-7%	4%
Arthritis/joint problems	6-11%	10%	(-1)-3%	2%
GI problems	15%		5-7%	1%
Respiratory problem	4-7%	2%	2-5%	1%
Chronic fatigue syndrome	1-4%	3%		0%
Post-traumatic stress disorder	2-6%	9%	6%	3%
Chronic multisymptom illness	13-25%	26%

Depleted uranium

Depleted uranium (DU) was used in tank artillery shells and machine-gun ordnance on a large scale for the first time in the Gulf War. DU munitions often burn when they impact a hard target, producing toxic combustion products. [5] The toxicity, effects, distribution, and exposure involved have all been the subject of a lengthy and complex debate. As of 2005, little was known about the extent Gulf War soldiers exposure to DU.

Because uranium is a heavy metal and chemical toxicant with nephrotoxic (kidney-damaging) [6], teratogenic (birth defect-causing) [7] [8], and potentially carcinogenic [9] properties, uranium exposure is associated with a variety of illnesses [10]. The chemical toxicological hazard posed by uranium dwarfs its radiological hazard because it is only weakly radioactive, and depleted uranium even less so. In 2005, uranium metalworkers at a Bethlehem plant near Buffalo, New York, exposed to frequent occupational uranium inhalation risks, were alleged by non-scientific sources to have the same patterns of symptoms and illness as Gulf War Syndrome victims [11] [12].

Early studies of depleted uranium aerosol exposure assumed that uranium combustion product particles would quickly settle out of the air [13] and thus could not affect populations more than a few kilometers from target areas [14], and that such particles, if inhaled, would remain undissolved in the lung for a great length of time and thus could be detected in urine [15]. Uranyl ion contamination has been found on and around depleted uranium targets [16].

A study of U.K. veterans who thought they might have been exposed to DU showed abberations in their white blood cell chromosomes. [17] Mice immune cells exposed to uranium exhibit abnormalities. [18]

GWI has recently been recognized as involving neurotoxins. In 2005, depleted uranium was shown to be a neurotoxin in rats [19].

Increases in the rate of birth defects for children born to Gulf War veterans have been reported. A 2001 survey of 15,000 U.S. Gulf War combat veterans and 15,000 control veterans found that the Gulf War veterans were 1.8 (fathers) to 2.8 (mothers) times as likely to report having children with birth defects [20]. In early 2004, the U.K. Pensions Appeal Tribunal Service attributed birth defect claims from a February 1991 Gulf War combat veteran to depleted uranium poisoning [21] [22].

In the Balkans war zone where depleted uranium was also used, an absence of problems is seen by some as evidence of DU muntions' safety. "Independent investigations by the World Health Organization, European Commission, European Parliament, United Nations Environment Programme, United Kingdom Royal Society, and the Health Council of the Netherlands all discounted any association between depleted uranium and leukemia or other medical problems." [23] Since then, there has been a resurgence of interest in the health effects of depleted uranium.

Anthrax vaccine

The early 1990s version of the Anthrax vaccine was a source of several serious side effects including GWI symptoms. The vaccine was particularly painful when administered, and often caused a severe local skin reaction that lasted for weeks or months. [24] While FDA approved, it never went through large scale clinical trials, in comparison to almost all other vaccines in the United States. [25]

Data linking squalene in the vaccine to Gulf War Syndrome was "presented in the peer-reviewed February 2000 and August 2002 articles. The published findings (1) strongly suggest that the GWS-like illness being reported by all of the various patient groups is the same illness, (2) strongly suggest that the contaminated vaccine caused the illness in the AVIP group, and (3) further suggest that squalene contamination of one or more 1990-1991-era vaccines accounts for the GWS cases from that era." [26] The sickest veterans tended to have the highest levels of squalene antibodies in their bloodstream. [27]

Even after the war, troops that had never been deployed overseas, after receiving the anthrax vaccine, developed symptoms similar to those of Gulf War Syndrome. The Pentagon failed to report to Congress 20,000 cases where soldiers were hospitalized after receiving the vaccine between 1998 and 2000. [28]

252 Members of a U.S. Air Force Squadron who received the vaccine were surveyed, and 139 of these returned their questionares. Of these, 58% reported reactions, often consistent with some features of a Gulf War Syndrome type illness, including: joint and muscle pain (41%), decreased energy and tiredness (29%), reduced concentration (28%), short-term memory loss (24%), and sleep problems (17%). [29]

In 2000, a medical examiner ruled that anthrax vaccine was a contributing factor in the death of a civilian who helped manufacture the vaccine given to U.S. troops. [30] That same year, a Canadian judge ruled that the anthrax vaccine was potentially unsafe, halting the trial of a soldier who had been court-martialled for refusing to take it. [31]

Despite repeated assurances that the vaccine was safe and necessary, a U.S. Federal Judge ruled that there was good cause to believe it was harmful, and he ordered the Pentagon to stop administering it in October 2004. [32] That ban has not been lifted. Anthrax vaccine is the only substance suspected in Gulf War syndrome to which forced exposure has since been banned to protect troops from it.

In July 2005, a U.S. soldier was awarded a disability pension for medical problems which developed after his anthrax vaccination, after a Federal Appeals Court ruled in his favor. [33]

On December 15, 2005, the Food and Drug Administration, released a Final Order finding that anthrax vaccine is safe and effective. [34] All vaccines cause adverse events in a subset of those to whom they are administered. [35], [36] Women who receive the vaccine get pregnant and deliver children at the same rates as unvaccinated women. [37] Anthrax vaccination has no effect on pregnancy and birth rates or adverse birth outcomes. [38]

Note: the anthrax vaccine used in the early 1990s was different than the vaccine approved for use today. [39]

Infectious diseases

Along with possible confounding problems caused by exposure to more than one of the substances listed above, comorbidities with infectious diseases have also not been ruled out. [40] Suspected diseases include leishmaniasis, from sandfly bites, and fungal mycoplasma parasites.

There are some who believe that Gulf War Syndrome is the result of a contagious bacteria. There are anecdotal reports of improvement in some victims when treated with antibiotics. [41] [42]

Chemical weapons

Many of the symptoms, other than low cancer incidence rates, of Gulf War syndrome are identical to those experienced in organophosphate poisoning. Gulf War veterans were exposed to a number of sources of these compounds, including nerve gas and pesticides. [43] [44]

Over 125,000 U.S. troops and 9,000 UK troops were exposed to nerve gas and mustard gas when an Iraqi depot in Khamisiyah, Iraq was bombed in 1991. [45]

One of the most unusual events during the build-up and deployment of British forces into the desert of Saudi Arabia was the constant alarms from the NIAD detection systems deployed by all British forces in theatre. The NIAD is a chemical and biological detection system that is set-up some distance away from a deployed unit, and will set off an alarm automatically if an agent is detected. During the troop build-up, these detectors were set off on a large number of occasions, making the soldiers don their respirators. Many reasons were given for the alarms, ranging from fumes from helicopters, fumes from passing jeeps, cigarette smoke and even deodorant worn by troops manning the NIAD posts. Although the NIAD had been deployed countless times in peacetime exercises in the years before the gulf war, the large number of alarms was to say the least very unusual and reasons given something of a joke among the troops. [46]

The Riegle Report said that chemical alarms went off 18,000 times during the Gulf War. The United States did not have any biological agent detection capability whatsoever during the Persian Gulf War. After the air war started on January 16, 1991, coalition forces were chronically exposed to low (nonlethal) levels of chemical and biological agents released primarily by direct Iraqi attack via missiles, rockets, artillery, or aircraft munitions and by fallout from allied bombings of Iraqi chemical warfare munitions facilities. - Chemical detection units from the Czech Republic confirmed chemical agents. - French detection units detected chemical agents. - Chemical specialists from the British Army detected chemical agents. - Both Czech and French forces reported detections immediately to U.S. forces. - U.S. forces detected, confirmed, and reported chemical agents; and - U.S. soldiers were awarded medals for detecting chemical agents. [47]

Some, including Richard Guthrie, an expert in chemical warfare at Sussex University, have argued that a likely cause for the increase in birth defects was the Iraqi Army’s use of teratogenic mustard agents. Plaintifs in a long-running class action lawsuit continue to assert that sulphur mustards might be responsible [48].

Other causes no longer suspected

Various causes suggested have been eliminated from consideration by authorities:

• smoke from oil well fires,
• post-traumatic stress disorder and other psychological and psychosomatic causes,
• multiple chemical sensitivity,
• biological weapons,
• inhibited red-fuming nitric acid (IRFNA), a rocket fuel/oxidizing agent used in SS-1 Scud (and derived) ballistic missiles, SA-2 Guideline surface-to-air missiles and possibly other pieces of Iraqi military technology. [49], and
• military experimentation

During the war, several oil wells were set on fire, and the smoke from those fires was inhaled by large numbers of solders, many of whom suffered acute pulmonary and other chronic effects, including asthma and bronchitis. However, none of the firefighter companies assigned to the oil well fires encountering the smoke but not combat have had any GWI symptoms [50] (pages 148, 154, 156).

Controversy

There has been considerable controversy over whether or not Gulf War syndrome is a physical medical condition related to sufferers' Gulf War service (or relation to a Gulf War veteran).

Evidence for

United States Veterans Affairs Secretary Anthony Principi's panel found that pre-2005 studies suggested the veterans' illnesses are neurological and apparently are linked to exposure to neurotoxins, such as the nerve gas sarin, the anti-nerve gas drug pyridostigmine bromide, and pesticides that affect the nervous system.

"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," the review committee said.

In November, 2004, the anonymously-funded British inquiry headed by Lord Lloyd ([51]) concluded, for the first time, that thousands of UK and US Gulf War veterans were made ill by their service. The report claimed that Gulf veterans were twice as likely to suffer from ill health than if they had been deployed elsewhere, and that the illnesses suffered were the result of a combination of causes. These included multiple injections of vaccines, the use of organophosphate pesticides to spray tents, low level exposure to nerve gas, and the inhalation of depleted uranium dust. [52][53] The report was the first to suggest a direct link between military service in the Persian Gulf and illnesses suffered by veterans of that war and directly contradicts other theories which have suggested GWS is not a physical illness, but a response to the stresses of war.

Although not identifying Gulf War syndrome by name, in June of 2003 the High Court of England and Wales upheld a claim by Shaun Rusling that the depression, eczema, fatigue, nausea and breathing problems that he experienced after returning from the Gulf War were attributed to his military service.

A 2004 British study comparing 24,000 Gulf War veterans to a control group of 18,000 men found that those who had taken part in the Gulf war have lower fertility and are 40 to 50% more likely to be unable to start a pregnancy. Among Gulf war soldiers, failure to conceive was 2.5% vs. 1.7% in the control group, and the rate of miscarriage was 3.4% vs. 2.3%. These differences are small but statistically significant. [54]

In January 2006, a study led by Melvin Blanchard and published by the Journal of Epidemiology, part of the "National Health Survey of Gulf War-Era Veterans and Their Families", stated that veterans deployed in the Persian Gulf War had nearly twice the prevalence of chronic multisymptom illness (CMI), a cluster of symptoms similar to a set of conditions often called Gulf War Syndrome. [55]

Evidence against

Similar syndromes have been seen as an after effect of other conflicts — for example, 'shell shock' after World War I, and post-traumatic stress disorder (PTSD) after the Vietnam War. It should be noted that shell-shock and PTSD are the same condition. A review of the medical records of 15,000 U.S. Civil War soldiers showed that "those who lost at least 5% of their company had a 51% increased risk of later development of cardiac, gastrointestinal, or nervous disease." [56]

A 14 November 1996 article in the New England Journal of Medicine found no difference in death rates or hospitalization rates between Persian Gulf vets and non-Persian Gulf vets.

Additionally, some reported symptoms cannot be verified or connected to Gulf War service. Pfc. Brian Martin, a Gulf War veteran who has appeared on multiple talk shows and given interviews to many newspapers and magazines about Gulf War syndrome, reported developing lupus erythematosus, which news articles claim had been verified by federal medical exams, despite the Department of Veterans Affairs's denial of having had any patients with it.

See also

• Beyond Treason (2005 documentary)

External links

• American Gulf War Veterans Association
• My Life Living With Depleted Uranium
• National Gulf War Resource Center
• Radioactive Wounds of War
• Research Advisory Committee on Gulf War Veterans' Illnesses
• Uranium Medical Research Centre, founded in 1997 by Dr. Asaf Durakovic, M.D., formerly Chief of Professional Clinical Services in the U.S. Army's 531st Medical Detachment during the Desert Shield phase of the 1991 Gulf War and head of the Veteran's Administration Nuclear Medicine facility in Wilmington, Delaware.
• Veterans for Common Sense
• Post Conflict Assessment Iraq by the United Nations Environment Programme (PDF.)
• Documentary: Beyond Treason
• First Gulf War still claims lives from the Seattle Post-Intelligencer
• New York Daily News Special Investigation: Poisoned?, Inside camp of troubles, Soldiers demand to know health risks (April 3, 2005), and Army to test N.Y. Guard unit (April 5, 2005)
• Have DU Will Travel series of sixteen articles in the Crawford, Texas Lone Star Iconoclast
• In Vitro Immune Toxicity of Depleted Uranium: Effects on Murine Macrophages, CD4+ T Cells, and Gene Expression Profiles, by B. Wan, J.T. Fleming, T.W. Schultz, and G.S. Sayler (2006) Environ Health Perspect. 114, 85-91.
• "After the Dust Settles" (Bulletin of the Atomic Scientists report from 1999)
• Gulf Lore Syndrome (1999)